Surgery versus surveillance: A quality-of-life analysis of patients with moderately dilated aortic root or ascending aorta.

Objectives: The impact of diagnosis and management of ascending thoracic aortic aneurysm (ATAA) on patients' quality of life (QoL) is not well characterized. This study aims to compare QoL with surgery versus surveillance in patients with moderate ATAAs.

Methods: Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance is a multicentre randomized trial for patients with ATAA between 5.

Safety of Concomitant Ascending Aortic Aneurysm Repair During Coronary Artery Bypass Grafting: A Society of Thoracic Surgeons Database Study.

Background: The 2022 ACC/AHA Aortic Disease guideline recommends concomitant ascending aortic replacement at the same size criteria for all cardiac operations. We sought to determine the added risk of performing an elective prophylactic ascending aortic replacement during coronary artery bypass grafting (CABG) using the STS database.

Methods: The STS database was queried for all elective adult CABG patients from 2014-2022 with either triple vessel or left main disease >50%.

Aortic valve-sparing root operation in patients with Marfan and Loeys-Dietz syndrome.

Background: The objective of this study was to evaluate the mid-term outcomes of valve-sparing aortic root replacement (VSRR) in patients with Marfan (MFS) and Loeys-Dietz syndrome (LDS). Additionally, we analyzed operative factors, including the impact of graft selection.

Methods: All patients with either MFS (158, 84%) or LDS (30, 16%) who underwent VSRR were included in a retrospective analysis from a transatlantic registry.

Anatomic predictors of distal landing zone failure after endovascular repair of thoracic aortic aneurysm†.

Objectives: To analyse anatomic factors of the distal landing zone (dLZ) associated with the durability of endovascular repair of thoracic aortic aneurysm (TAA).

Methods: Consecutive patients undergoing thoracic endovascular aortic repair (TEVAR) for undissected TAA were queried from a single centre from 2004 to 2022. Patient and operative factors were considered as well as detailed anatomic factors at the dLZ assessed by 3D reconstruction of pre-TEVAR imaging.

TOWARDS PATIENT-SPECIFIC SURGICAL PLANNING FOR BICUSPID AORTIC VALVE REPAIR: FULLY AUTOMATED SEGMENTATION OF THE AORTIC VALVE IN 4D CT.

The bicuspid aortic valve (BAV) is the most prevalent congenital heart defect and may require surgery for complications such as stenosis, regurgitation, and aortopathy. BAV repair surgery is effective but challenging due to the heterogeneity of BAV morphology. Multiple imaging modalities can be employed to assist the quantitative assessment of BAVs for surgical planning.

National Trends in the Use and Timing of Thoracic Endovascular Aneurysm Repair After Type B Aortic Dissection.

Background: The optimal management of uncomplicated type B aortic dissection (TBAD) has become controversial in recent years, especially concerning the use and timing of thoracic endovascular aneurysm repair (TEVAR). Here, we analyze a large national cohort over 11 years to understand the current national landscape of TBAD management, trends over time, and disparities in care across the United States.

Methods: Admissions for acute TBAD from 2010 to 2020 were identified in the Nationwide Readmissions Database, a large nationally representative sample of hospital admissions across 30 states.

Genome-First Approach to Rare and Common Variant Risk of Thoracic Aortic Aneurysm and Dissection.

Background: Thoracic aortic aneurysm and dissection (TAAD) can have catastrophic health consequences. Eleven genes have strong or definitive evidence for causing heritable TAAD (HTAAD). However, patients are seldom tested for rare pathogenic (P) or likely pathogenic (LP) variants in these HTAAD genes absent a strong family history or syndromic features, and little is known about either their prevalence in the general population or the associated TAAD risk.

Predicting Thoracic Aortic Dissection in a Diverse Biobank Using a Polygenic Risk Score.

Background: Thoracic aortic dissection is a life-threatening condition that often occurs in the presence of aortic dilation. However, currently there are limited clinical risk factors beyond aortic diameter (AoD) used to determine individual-level dissection risk.

Objectives: The purpose of this study was to determine whether common variant genetics can be used to improve identification of individuals most at risk for dissection.

Long-term outcomes of thoracic endovascular aortic repair for descending thoracic aortic aneurysms based on pooled results from FDA clinical trials.

Objective: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for descending thoracic aortic aneurysms, but long-term data are limited. This study assessed long-term results of TEVAR in early recipients of TEVAR devices who were enrolled in US Food and Drug Administration investigational device exemption clinical trials for aneurysm.

Methods: This was a single-center retrospective study including 179 patients enrolled in 14 clinical trials for TEVAR for descending thoracic aortic aneurysm between 2000 and 2019.

First reported surgical explantation of infected thoracic branched endograft requiring complex arch and descending thoracic aortic repair.

We present a 51-year-old woman with thoracic aortitis and rapidly enlarging descending thoracic aortic aneurysm in the setting of Clostridium septicum bacteraemia. After antibiotic treatment, she underwent left carotid-subclavian transposition and endovascular repair with thoracic branched endograft (TBE) with left carotid artery coverage. Three months postoperatively, she developed endograft infection, with a rapidly enlarging pseudoaneurysm at the proximal landing zone.

Malperfusion in Patients With Acute Type A Aortic Dissection: A Nationwide Analysis.

Background: This study describes in detail the clinical burden of malperfusion associated with acute type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.

Methods: All patients undergoing repair of ATAAD between 2017 and 2020 in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions on the basis of imaging or the surgeon's evaluation.

Revisiting ascending aortic resection in the elective valve-sparing root replacement: assessing the benefits and necessity of hemiarch replacement at three centres†.

Objective: The aim of this study was to determine the indication and optimal timing for performing a hemiarch procedure in patients undergoing valve-sparing root replacement (VSRR).

Methods: We conducted a retrospective study on 986 patients undergoing VSRR at three tertiary care centres. Inclusion criteria were all patients undergoing elective VSRR.

The Challenges of Aortic Valve Management After Left Ventricular Assist Device Implantation.

Background: Continuous retrograde flow across the aortic valve from left ventricular assist device (LVAD) therapy can result in cusp damage and progressive aortic regurgitation, potentially triggering recurrent heart and multiorgan failure. The management of aortic regurgitation after LVAD implantation has not been well defined.

Methods: This study retrospectively reviewed the investigators' experience with the management of de novo aortic regurgitation requiring intervention in patients with continuous-flow LVAD.

A Multicenter Clinical Trial on the Five-Year Outcomes Following Treatment of Acute, Complicated Type B Aortic Dissection With a Conformable Stent Graft.

Background: Thoracic endovascular aortic repair (TEVAR) has become the treatment of choice for acute, complicated type B aortic dissections. The purpose of this study was to evaluate the 5-year outcomes of the GORE thoracic aortic graft (TAG) 08-01 study on TEVAR for acute, complicated type B aortic dissections using the GORE conformable TAG thoracic endoprosthesis (CTAG) and to establish if late aortic complications are avoided and remodeling is sustained.

Methods: From January 2010 to February 2017, 50 patients with acute, complicated type B aortic dissections were enrolled from 26 sites in the United States in this prospective, nonrandomized study.

Contribution margins and utilization of transcatheter aortic valve replacement versus surgical aortic valve replacement in the Medicare population.

Background: Hospitals and health systems must balance the demand for transcatheter aortic valve replacement (TAVR) against financial sustainability. Patients may be eligible for both TAVR and surgical aortic valve replacement (SAVR), but financial realities for hospitals may affect differential access to those therapies. We sought to understand the landscape of costs and reimbursement for TAVR and SAVR in the US and to understand the association of procedural reimbursement with receipt of either.

Development of a Novel Society of Thoracic Surgeons Aortic Surgery Mortality and Morbidity Risk Model.

Background: The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was expanded in 2017 to include more granular detail on thoracic aortic surgeries. We describe the first validated risk model in thoracic aortic surgery from the STS ACSD.

Methods: The study population consisted of patients undergoing nonemergent isolated ascending aortic aneurysm repair by open or clamped distal anastomoses, including those requiring aortic root or valve replacement.

Polygenic Scoring for Detection of Ascending Thoracic Aortic Dilation.

Background: Ascending thoracic aortic dilation is a complex heritable trait that involves modifiable and nonmodifiable risk factors. Polygenic scores (PGS) are increasingly used to assess risk for complex diseases. The degree to which a PGS can improve aortic diameter prediction in diverse populations is unknown.

Outcomes of a Novel Single-Branched Aortic Stent Graft for Treatment of Type B Aortic Dissection.

Background: Intervention on type B dissection frequently requires landing the proximal edge of the stent graft between the left common carotid artery and left subclavian artery (LSA). The GORE TAG thoracic branch endoprosthesis is a technology that allows LSA preservation with a single internal branch.

Methods: This study was a prospective nonrandomized single-arm clinical trial of patients with type B aortic dissection who were treated with the single-branched device.

Clinical cases referring to the 2023 EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ.

Clinical cases referring to the EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ aim to assist physicians in selecting the best management strategies for individual patients with a given condition. These expert opinions consider the impact on patient outcomes as well as the risk-benefit ratio of different diagnostic or therapeutic methods. These cases serve as a vital tool to aid physicians in making decisions in their daily practice.