Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspective
Background: Whether elderly patients with aortic root or ascending aortic aneurysm (ATAA) would benefit from the new surgical size threshold of 5.0 cm is unknown. This study aimed to evaluate the natural history of ATAA in elderly patients and to compare long-term outcomes of those who underwent ini...
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Elsevier
2024-12-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273624002493 |
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| author | Veronica F. Chan, BSc Ming Hao Guo, MD, MSc Thais Coutinho, MD Aryan Ahmadvand, BSc Mahdi Zeghal, BSc Adam Mussani, BSc Talal Al-Atassi, MD, MPH Roy Masters, MD David Glineur, MD, PhD Munir Boodhwani, MD, MSc |
| author_facet | Veronica F. Chan, BSc Ming Hao Guo, MD, MSc Thais Coutinho, MD Aryan Ahmadvand, BSc Mahdi Zeghal, BSc Adam Mussani, BSc Talal Al-Atassi, MD, MPH Roy Masters, MD David Glineur, MD, PhD Munir Boodhwani, MD, MSc |
| author_sort | Veronica F. Chan, BSc |
| collection | DOAJ |
| description | Background: Whether elderly patients with aortic root or ascending aortic aneurysm (ATAA) would benefit from the new surgical size threshold of 5.0 cm is unknown. This study aimed to evaluate the natural history of ATAA in elderly patients and to compare long-term outcomes of those who underwent initial surveillance versus surgery. Methods: Patients age ≥75 years with an ATAA ≥40 mm were categorized into 2 groups: initial surgery and initial surveillance. The primary outcome was all-cause mortality; Kaplan-Meier curves were plotted for survival. A multivariable Cox proportional hazard regression model was used to identify independent predictors of long-term mortality. Results: The study series comprised 300 patients, including 58 who underwent initial surgery and 242 who received surveillance between July 2010 and September 2022. In the surveillance cohort, the mean aneurysm growth rate was 0.10 cm/year. Comparing surveillance to surgery, at 8 years there was no difference in survival (mean, 77.8 ± 3.4% vs 71.8 ± 9.6%; P = .65). For 116 patients with an initial aneurysm diameter ≥5.0 cm, there was no difference in survival between the 2 groups at 8 years (76.5 ± 7.0% vs 68.4 ± 11.3%; P = .20). Larger body surface area (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.09-1.90; P = .01) and history of smoking (HR, 2.25; 95% CI, 1.27-3.98; P = .01) were identified as predictors of long-term mortality. Conclusions: In our series of elderly patients with ATAA, there was no difference in 8-year survival between initial surveillance and surgical management, with a high competing risk of nonaortic mortality. Surveillance may be a reasonable alternative to surgery for selected older adults with ATAA <5.5 cm. |
| format | Article |
| id | doaj-art-95977b4cb81143a8ae0c2c1bf2fee0d1 |
| institution | OA Journals |
| issn | 2666-2736 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | JTCVS Open |
| spelling | doaj-art-95977b4cb81143a8ae0c2c1bf2fee0d12025-08-20T02:35:42ZengElsevierJTCVS Open2666-27362024-12-012213214310.1016/j.xjon.2024.08.021Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspectiveVeronica F. Chan, BSc0Ming Hao Guo, MD, MSc1Thais Coutinho, MD2Aryan Ahmadvand, BSc3Mahdi Zeghal, BSc4Adam Mussani, BSc5Talal Al-Atassi, MD, MPH6Roy Masters, MD7David Glineur, MD, PhD8Munir Boodhwani, MD, MSc9Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MinnDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDepartment of Medicine, University of Ottawa, Ottawa, Ontario, CanadaInterdisciplinary Medical Sciences, Western University, London, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, Eastern Health, St John’s, Newfoundland and Labrador, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Address for reprints: Munir Boodhwani, MD, MSc, Division of Cardiac Surgery, University of Ottawa Heart Institute, 340-40 Ruskin St, Ottawa, Ontario, Canada K1Y 4W7.Background: Whether elderly patients with aortic root or ascending aortic aneurysm (ATAA) would benefit from the new surgical size threshold of 5.0 cm is unknown. This study aimed to evaluate the natural history of ATAA in elderly patients and to compare long-term outcomes of those who underwent initial surveillance versus surgery. Methods: Patients age ≥75 years with an ATAA ≥40 mm were categorized into 2 groups: initial surgery and initial surveillance. The primary outcome was all-cause mortality; Kaplan-Meier curves were plotted for survival. A multivariable Cox proportional hazard regression model was used to identify independent predictors of long-term mortality. Results: The study series comprised 300 patients, including 58 who underwent initial surgery and 242 who received surveillance between July 2010 and September 2022. In the surveillance cohort, the mean aneurysm growth rate was 0.10 cm/year. Comparing surveillance to surgery, at 8 years there was no difference in survival (mean, 77.8 ± 3.4% vs 71.8 ± 9.6%; P = .65). For 116 patients with an initial aneurysm diameter ≥5.0 cm, there was no difference in survival between the 2 groups at 8 years (76.5 ± 7.0% vs 68.4 ± 11.3%; P = .20). Larger body surface area (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.09-1.90; P = .01) and history of smoking (HR, 2.25; 95% CI, 1.27-3.98; P = .01) were identified as predictors of long-term mortality. Conclusions: In our series of elderly patients with ATAA, there was no difference in 8-year survival between initial surveillance and surgical management, with a high competing risk of nonaortic mortality. Surveillance may be a reasonable alternative to surgery for selected older adults with ATAA <5.5 cm.http://www.sciencedirect.com/science/article/pii/S2666273624002493aortic root aneurysmascending aortic aneurysmelderlyguideline |
| spellingShingle | Veronica F. Chan, BSc Ming Hao Guo, MD, MSc Thais Coutinho, MD Aryan Ahmadvand, BSc Mahdi Zeghal, BSc Adam Mussani, BSc Talal Al-Atassi, MD, MPH Roy Masters, MD David Glineur, MD, PhD Munir Boodhwani, MD, MSc Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspective JTCVS Open aortic root aneurysm ascending aortic aneurysm elderly guideline |
| title | Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspective |
| title_full | Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspective |
| title_fullStr | Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspective |
| title_full_unstemmed | Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspective |
| title_short | Surgery versus surveillance for ascending aortic aneurysms in elderly patientsCentral MessagePerspective |
| title_sort | surgery versus surveillance for ascending aortic aneurysms in elderly patientscentral messageperspective |
| topic | aortic root aneurysm ascending aortic aneurysm elderly guideline |
| url | http://www.sciencedirect.com/science/article/pii/S2666273624002493 |
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