Impact of nondiameter aortic indices on surgical eligibility: Results from the Treatment in Thoracic Aortic Aneurysm: Surgery Versus Surveillance (TITAN: SvS) randomized controlled trial.

Autor:	Dagher O; Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Alberta, Canada; Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada., Appoo JJ; Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Alberta, Canada. Electronic address: jappoo@ucalgary.ca., Herget E; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada., Atoui R; Division of Cardiothoracic Surgery, Northern Ontario School of Medicine, Sudbury, Ontario, Canada., Baeza C; Division of Cardiac Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio., Brinkman W; Division of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, Tex., Bozinovski J; Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio., Chu MWA; Division of Cardiac Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada., Dagenais F; Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada., Demers P; Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada., Desai N; Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pa., El-Hamamsy I; Division of Cardiothoracic Surgery, Mount Sinai Hospital, New York, NY., Estrera A; Department of Cardiothoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex., Grau JB; Division of Cardiothoracic Surgery, The Valley Hospital, Ridgewood, NJ., Hughes GC; Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC., Jassar A; Division of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Mass., Kachroo P; Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo., Lachapelle K; Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada., Ouzounian M; Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada., Patel HJ; Division of Cardiiothoracic Surgery, University of Michigan Hospital, Ann Arbor, Mich., Pozeg Z; Division of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New-Brunswick, Canada., Tseng E; Division of Cardiothoracic Surgery, University of California, San Francisco Medical Center, San Francisco, Calif., Whitlock R; Division of Cardiac Surgery, Population Health Research Institute, Hamilton, Ontario, Canada., Guo MH; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Boodhwani M; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Apr 29. Date of Electronic Publication: 2024 Apr 29.
DOI:	10.1016/j.jtcvs.2024.04.010
Abstrakt:	Objectives: Traditional criterion for intervention on an asymptomatic ascending aortic aneurysm has been a maximal aortic diameter of 5.5 cm or more. The 2022 American College of Cardiology/American Heart Association aortic guidelines adopted cross-sectional aortic area/height ratio, aortic size index, and aortic height index as alternate parameters for surgical intervention. The objective of this study was to evaluate the impact of using these newer indices on patient eligibility for surgical intervention in a prospective, multicenter cohort with moderate-sized ascending aortic aneurysms between 5.0 and 5.4 cm. Methods: Patients enrolled from 2018 to 2023 in the randomization or registry arms of the multicenter trial, Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance, were included in the study. Clinical data were captured prospectively in an online database. Imaging data were derived from a core computed laboratory. Results: Among the 329 included patients, 20% were female. Mean age was 65.0 ± 11.6 years, and mean maximal aortic diameter was 50.8 ± 3.9 mm. In the one-third of all patients (n = 109) who met any 1 of the 3 criteria (ie, aortic size index ≥3.08 cm/m 2 , aortic height index ≥3.21 cm/m, or cross-sectional aortic area/height ≥ 10 cm 2 /m), their mean maximal aortic diameter was 52.5 ± 0.52 mm. Alternate criteria were most commonly met in women compared with men: 20% versus 2% for aortic size index (P < .001), 39% versus 5% for aortic height index (P < .001), and 39% versus 21% for cross-sectional aortic area/height (P = .002), respectively. Conclusions: One-third of patients in Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance would meet criteria for surgical intervention based on novel parameters versus the classic definition of diameter 5.5 cm or more. Surgical thresholds for aortic size index, aortic height index, or cross-sectional aortic area/height ratio are more likely to be met in female patients compared with male patients. Competing Interests: Conflict of Interest Statement M.B. receives consulting fees from Gore Medical and Edwards Lifesciences. J.J.A. receives consulting fees from Artivion, Gore Medical, and Alexion. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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