Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application?

The Journal of Thoracic and Cardiovascular Surgery

Ayman Saeyeldin¹  Mohamed Abdelbaky²  Mohammad A. Zafar³  Yupeng Li⁴  Maryam Tanweer⁵  Anton Gryaznov⁶ 

[1] 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;Department of Internal Medicine, Saint Mary's Hospital, Waterbury, Conn;Department of Political Sciences and Economics, Rowan University, Glassboro, NJ;Department of Surgery, Saint Mary's Hospital, Waterbury, Conn;Department of Vascular Surgery, Yale University School of Medicine, New Haven, Conn

关键词: thoracic aorta;    thoracic aortic aneurysm;    natural history;    aortic dissection;    aortic rupture;    clinical outcomes;    clinical care;    decision making;   

DOI  :  10.1016/j.jtcvs.2018.09.124

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveThe 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.MethodsA 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).ResultsIn 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 P = .04), respectively. Death ensued in 20 patients (15.6%) versus 6 patients (3.3%) (P ConclusionsPatients 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.

【 授权许可】

Unknown