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. 2024 Mar;167(3):918-926.e3.
doi: 10.1016/j.jtcvs.2022.03.032. Epub 2022 Apr 9.

Differential expansion and outcomes of ascending and descending degenerative thoracic aortic aneurysms

Ying Huang  1 , Hartzell V Schaff  2 , Gabor Bagameri  1 , Alberto Pochettino  3 , Randall R DeMartino  4 , Austin Todd  5 , Kevin L Greason  1
Affiliations

Differential expansion and outcomes of ascending and descending degenerative thoracic aortic aneurysms

Ying Huang et al. J Thorac Cardiovasc Surg. 2024 Mar.

Abstract

Objective: To evaluate expansion of degenerative thoracic aortic aneurysms (TAAs) and compare results between ascending and descending TAAs.

Methods: Among patients with diagnosis of degenerative TAA (1995-2015) in Olmsted County, we studied those having at least 2 computed tomography scans of TAA throughout the follow-up. Patients were classified as ascending or descending groups according to the segment where the maximal aortic diameter was measured. Primary end points were expansion rates and factors associated with TAA growth.

Results: We investigated 137 patients, 70 (51.1%) of whom were women; 78 (56.9%) were in the ascending and 59 (43.1%) were in the descending group. Median baseline maximal aortic diameter was 48.5 mm (interquartile range, 47.0-49.9 mm) for ascending and 42.4 mm (interquartile range, 40.0-45.4 mm) for descending group (P < .001). Median expansion rate was higher in the descending than the ascending group (2.0 mm/year [interquartile range, 0.9-3.2 mm/year] vs 0.2 mm/year [IQR, 0.1-0.6 mm/year]; P < .001). Aneurysm in the descending aorta and larger baseline maximal aortic diameter were independently associated with TAA expansion. Advanced age and chronic obstructive pulmonary disease but not aneurysm size or location were independently associated with overall mortality (P < .05). Aneurysm in the descending aorta was associated with aortic-related events (P < .05).

Conclusions: Degenerative TAAs under surveillance expand slowly. Descending TAA and larger baseline maximal aortic diameter were independently associated with more rapid TAA expansion, but these factors did not influence all-cause mortality.

Keywords: aortic-related events; expansion; mortality; thoracic aortic aneurysm.

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Conflict of interest statement

Conflict of Interests: None.

Figures

Figure 1.
Figure 1.
Predicted changes in maximal aortic diameter over time for overall (A) and ascending and descending groups (B).
Figure 2.
Figure 2.
Kaplan-Meier curves of survival for ascending and descending groups. Patients in the descending group were older than those in the ascending group (79.0 vs. 73.0 years, P<.001). (95% CI)
Figure 3.
Figure 3.
Kaplan-Meier curves for freedom from aortic-related events, adjusted for competing risk of death, for ascending and descending groups. (95% CI)
Figure 4.
Figure 4.
Summary of the study. Using Rochester Epidemiology Project database, we analyzed 137 Olmsted County residents with degenerative TAA confirmed between 1995 and 2015, who had at least two computed tomographic scans of TAA throughout the follow-up. Among these patients, 78 were in the ascending and 59 in the descending group. Degenerative TAAs under surveillance expand slowly, but median expansion rate was higher in the descending than the ascending group (P<.001). Patients in the ascending group had better survival and freedom from AREs than those in the descending group. Descending TAA was associated with more rapid TAA expansion and increased AREs, but it did not affect overall mortality. ARE, aortic-related events; MAD, maximal aortic diameter; TAA, thoracic aortic aneurysm. (Graphical Abstract)
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