Study Exposes Gaps In Aortic Dissection Care
Most patients die before reaching the hospital
Hyderabad: Aortic dissection is a rare but fatal heart condition caused by a tear in the aorta, the main artery carrying blood from the heart. It affects about five to six Indians per 1,00,000 each year, translating to thousands of cases, many misdiagnosed as heart attacks or strokes. Most patients die before reaching the hospital. The condition progresses fast and can be deadly within hours if untreated. The risk of death increases by one to two per cent every hour. Warning signs include sudden chest or back pain and fainting. Men over 50 and those with high blood pressure are most at risk, along with people suffering from Marfan syndrome or a bicuspid aortic valve. Emergency surgery is the only life-saving option.
A nationwide survey by Hyderabad-based heart surgeon Dr Lokeswara Rao Sajja has revealed major gaps in India’s treatment of acute type A aortic dissection (ATAAD), the most dangerous form of the condition. Published in the October 2025 issue of the Indian Journal of Thoracic and Cardiovascular Surgery, the study surveyed 200 cardiac surgeons and found wide variations in diagnosis time, surgical decisions, operating techniques and post-surgery care.
While some cardiac centres have adopted advanced surgical techniques, others continue to struggle with inadequate infrastructure, delayed diagnosis and late patient arrivals. Dr Sajja stressed that “timely surgery at specialised cardiac centres can save lives,” but noted that not all patients receive prompt treatment.
Nearly three-fourths of surveyed surgeons said they would not operate on patients aged above 80. Worryingly, some avoided surgery even for those in their sixties and seventies, despite evidence that many such patients recover well after timely intervention. Two-thirds of surgeons preferred operating within 24 hours of diagnosis, while almost one-third delayed surgery for up to three days — a dangerous delay that raises mortality risk.
Differences also appeared in the surgical approach. Most surgeons used the axillary artery near the shoulder to connect patients to the heart-lung machine, reducing brain injury risk. Others still relied on the femoral artery, which carries higher complications. Cooling techniques to protect the brain during surgery also varied.
Post-surgery monitoring practices were inconsistent, too. Most surgeons recommended annual CT scans, while others suggested more frequent follow-ups or none at all. MRI scans, which avoid radiation, were rarely used.
“Emergency surgery replaces the torn part of the aorta with an artificial graft. Earlier, we replaced only the ascending aorta, but newer techniques like the Frozen Elephant Trunk procedure combine open surgery with a stent graft. This not only fixes the tear but also protects other parts of the aorta, improving long-term survival,” Dr. Sajja said.
The study concludes that while Indian cardiac care is advancing, the lack of uniform protocols and infrastructure highlights the urgent need for India-specific treatment guidelines and better nationwide training for surgeons.