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- W2901071051 abstract "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.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).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.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." @default.
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- W2901071051 date "2019-05-01" @default.
- W2901071051 modified "2023-10-12" @default.
- W2901071051 title "Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application?" @default.
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- W2901071051 doi "https://doi.org/10.1016/j.jtcvs.2018.09.124" @default.
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