Month: August 2018

Sherene Shalhub, MD MPH FACS-New Studies

Hi Brian,

Hope this finds you well, I am working on the grant application for PCORI as I mentioned to you earlier. So more information will be coming in the next week.

“Also, I recently published these manuscripts recently that you may find to be of interest to your readership’

Association of variant arch anatomy with type B aortic dissection and hemodynamic mechanisms

· Type of Research: Retrospective cohort study

· Take Home Message: Compared with 367 controls, variant arch anatomy was observed on computed tomography scans of 40.5% of 185 patients with type B aortic dissection. On four-dimensional flow magnetic resonance imaging, patients with bovine arch had higher systolic wall shear stress compared with those with normal arch anatomy.

· Recommendation: This study suggests that aortic arch anatomy variants are more common in patients with type B aortic dissections, which might be explained by higher wall sheer shear stress.

Endovascular thoracic aortic repair in confirmed or suspected genetically triggered thoracic aortic dissection

· Type of Research: Retrospective analysis of prospectively collected National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) data

· Take Home Message: In 31 patients with descending thoracic aorta dissection treated with thoracic endovascular aortic repair, 13 (42%) required reintervention at a median of 7 months, 3 for retrograde ascending aorta dissection and 7 for thoracoabdominal aortic aneurysm repairs with stent graft explantation.

· Recommendation: This study suggests that patients with genetically triggered descending thoracic aorta dissection, treated with thoracic endovascular aortic repair, have a high risk of retrograde aortic dissection and reintervention.

Testing patterns for genetically triggered aortic and arterial aneurysms and dissections at an academic center

· Type of Research: Retrospective cohort study

· Take Home Message: In 36% of 75 patients suspected of having heritable mutations related to aortic or arterial aneurysms or dissections, genetic testing results were positive. Pathogenic mutation was confirmed in 57% of patients with a family history of diagnosed mutation and in 42% of those with a personal history of ascending aortic disease.

· Recommendation: The authors suggest appropriate genetic consultation and selective testing in patients suspected of having genetically triggered vascular disease and suggest the need for novel gene discovery.

Warm regards,

Sherene Shalhub, MD MPH FACS

Associate Professor of Surgery

Division of Vascular Surgery

University of Washington

More national history data needed for ascending aortic aneurysm

article source:

There was a low growth rate for moderately dilated ascending aorta, according to a systematic review and meta-analysis published in JAMA Network Open.

Ming Hao Guo, MD, of the division of cardiac surgery at University of Ottawa Heart Institute, Canada, and colleagues analyzed data from 8,800 patients (mean age, 58 years; 76% men) from 20 studies from 1946 to May 2017. Studies were included in the meta-analysis if they reported rate of dissection or rupture, growth rate or all-cause mortality in patients with ascending aortic aneurysm.

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Data that were extracted include study design, demographics, follow-up, sample size, initial aneurysm diameter, patient risk factors and comorbidities, incidence of dissection or rupture, aneurysm growth rate during follow-up, incidence of elective ascending aortic surgery, size at dissection or rupture and all-cause mortality. Total follow-up time was 31,823 patient-years.

At enrollment, the mean initial aneurysm size from 13 studies was 42.6 mm.

All studies had a combined effect estimate for annual growth rate of 0.61 mm per year (95% CI, 0.23-0.99; I2 = 92%). During a median follow-up of 4.2 years, the pooled incidence of elective aortic surgery was 13.82% (95% CI, 6.45-21.41; I2 = 56%).

The linearized rate of the composite outcome of aortic dissection, all-cause mortality and aortic rupture was 2.16% per patient-year (95% CI, 0.79-3.55, I2 = 64%). The linearized rate for all-cause mortality was 1.99% per patient-year (95% CI, 0.83-3.15; I2 = 84%).

Researchers did not find a significant relationship between the year of study completion and primary outcomes and initial aneurysm size.

“These results require cautious interpretation as a large number of patients in the studies who met guideline criteria for intervention underwent elective aortic surgery,” Guo and colleagues wrote. “More robust natural history data from prospective studies or randomized clinical trials are necessary to better inform clinical decision-making in patients with ascending aortic disease.”

In a related editorial, Thoralf M. Sundt, MD, chief of the division of cardiac surgery and director of the Corrigan Minehan Heart Center at Massachusetts General Hospital, wrote: “To be sure, for patients, once they have been told they have an aneurysm (read, ‘time bomb in your chest’), it is very hard to turn back the clock and reassure them that the likelihood of a catastrophe is low. I suspect the same is true, to some degree, among caregivers. Who among us wants to sit by watching and hoping that we do not get a phone call that an aorta has dissected? Furthermore, our outcome information is asymmetric. The absence of dissection is a nonevent; we do not see it because there is nothing to see. And, of course, we can never know how many of those aortas we replace would or would not have dissected.” – by Darlene Dobkowski

Disclosures: The authors and Sundt report no relevant financial disclosures.

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