Ayman Saeyeldin1, Mohammad A Zafar2, Yupeng Li3, Maryam Tanweer2, Mohamed Abdelbaky2, Anton Gryaznov4, Adam J Brownstein2, Camilo A Velasquez2, Joelle Buntin2, Kabir Thombre2, Wei-Guo Ma5, Young Erben6, John A Rizzo7, Bulat A Ziganshin8, John A Elefteriades9. 1. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Internal Medicine, Saint Mary's Hospital, Waterbury, Conn. 2. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn. 3. Department of Political Sciences and Economics, Rowan University, Glassboro, NJ. 4. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Surgery, Saint Mary's Hospital, Waterbury, Conn. 5. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing, China. 6. Department of Vascular Surgery, Yale University School of Medicine, New Haven, Conn. 7. Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY. 8. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia. 9. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn. Electronic address: john.elefteriades@yale.edu.
Abstract
OBJECTIVE: The risk of rupture and dissection in ascending thoracic aortic aneurysms increases as the aortic diameter exceeds 5 cm. This study evaluates the clinical effectiveness of a specific algorithm based on size and symptoms for preemptive surgery to prevent complications. METHODS: A total of 781 patients with nondissecting ascending thoracic aortic aneurysms who presented electively for evaluation to our institution from 2011 to 2017 were triaged to surgery (n = 607, 77%) or medical observation (n = 181, 24%) based on a specific algorithm: surgery for large (>5 cm) or symptomatic aneurysms. A total of 309 of 781 patients did not undergo surgery. Of these, 128 (16%) had been triaged to prompt repair but did not undergo surgery for a variety of reasons ("surgery noncompliant and overwhelming comorbidities" group). Another 181 patients (24%) were triaged to medical management ("medical" group). RESULTS: In the "surgery noncompliant and overwhelming comorbidities" versus the "medical" group, mean aortic diameters were 5 ± 0.5 cm versus 4.45 ± 0.4 cm and aortic events (rupture/dissection) occurred in 17 patients (13.3%) versus 3 patients (1.7%), respectively (P < .001). Later elective surgeries (representing late compliance in the "surgery noncompliant and overwhelming comorbidities group" or onset of growth or symptoms in the "medical" group) were conducted in 21 patients (16.4%) versus 15 patients (8.3%) (P = .04), respectively. Death ensued in 20 patients (15.6%) versus 6 patients (3.3%) (P < .001), respectively. In the "surgery noncompliant and overwhelming comorbidities" group, 7 of 20 patients died of definite aortic causes compared with none in the "medical" group. CONCLUSIONS: Patients with ascending thoracic aortic aneurysms who did not follow surgical recommendations experienced substantially worse outcomes compared with medically triaged candidates. The specific algorithm based on size and symptoms functioned effectively in the clinical setting, correctly identifying both at-risk and safe patients.
OBJECTIVE: The risk of rupture and dissection in ascending thoracic aortic aneurysms increases as the aortic diameter exceeds 5 cm. This study evaluates the clinical effectiveness of a specific algorithm based on size and symptoms for preemptive surgery to prevent complications. METHODS: A total of 781 patients with nondissecting ascending thoracic aortic aneurysms who presented electively for evaluation to our institution from 2011 to 2017 were triaged to surgery (n = 607, 77%) or medical observation (n = 181, 24%) based on a specific algorithm: surgery for large (>5 cm) or symptomatic aneurysms. A total of 309 of 781 patients did not undergo surgery. Of these, 128 (16%) had been triaged to prompt repair but did not undergo surgery for a variety of reasons ("surgery noncompliant and overwhelming comorbidities" group). Another 181 patients (24%) were triaged to medical management ("medical" group). RESULTS: In the "surgery noncompliant and overwhelming comorbidities" versus the "medical" group, mean aortic diameters were 5 ± 0.5 cm versus 4.45 ± 0.4 cm and aortic events (rupture/dissection) occurred in 17 patients (13.3%) versus 3 patients (1.7%), respectively (P < .001). Later elective surgeries (representing late compliance in the "surgery noncompliant and overwhelming comorbidities group" or onset of growth or symptoms in the "medical" group) were conducted in 21 patients (16.4%) versus 15 patients (8.3%) (P = .04), respectively. Death ensued in 20 patients (15.6%) versus 6 patients (3.3%) (P < .001), respectively. In the "surgery noncompliant and overwhelming comorbidities" group, 7 of 20 patients died of definite aortic causes compared with none in the "medical" group. CONCLUSIONS:Patients with ascending thoracic aortic aneurysms who did not follow surgical recommendations experienced substantially worse outcomes compared with medically triaged candidates. The specific algorithm based on size and symptoms functioned effectively in the clinical setting, correctly identifying both at-risk and safe patients.
Authors: Ayman Saeyeldin; Mohammad A Zafar; Lauren A Baldassarre; Hamid Mojibian; Bulat A Ziganshin; Sandip K Mukherjee; John A Elefteriades Journal: Int J Angiol Date: 2021-03-11
Authors: Sarah N Lipp; Elizabeth E Niedert; Hannah L Cebull; Tyler C Diorio; Jessica L Ma; Sean M Rothenberger; Kimberly A Stevens Boster; Craig J Goergen Journal: Front Physiol Date: 2020-05-12 Impact factor: 4.566
Authors: Wilfredo Luna Victoria-Medina; Carlos Quispe-Vizcarra; Miguel Rojas-Huillca; Milagros Moreno-Loaiza; W Samir Cubas Journal: Egypt Heart J Date: 2022-02-21