机构：[a]Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn[b]Department of Internal Medicine, Saint Mary’s Hospital, Waterbury, Conn[c]Department of Political Sciences and Economics, Rowan University, Glassboro, NJ[d]Department of Surgery, Saint Mary’s Hospital, Waterbury, Conn[e]Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing, China临床科室心脏外科中心血管科首都医科大学附属安贞医院[f]Department of Vascular Surgery, Yale University School of Medicine, New Haven, Conn[g]Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY[h]Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia.
Objective: The risk of rupture and dissection in ascending thoracic aortic aneurysms increases as the aortic diameter exceeds 5 cm. This study evaluates the clinical effectiveness of a specific algorithm based on size and symptoms for preemptive surgery to prevent complications. Methods: A total of 781 patients with nondissecting ascending thoracic aortic aneurysms who presented electively for evaluation to our institution from 2011 to 2017 were triaged to surgery (n = 607, 77%) or medical observation (n = 181, 24%) based on a specific algorithm: surgery for large (>5 cm) or symptomatic aneurysms. A total of 309 of 781 patients did not undergo surgery. Of these, 128 (16%) had been triaged to prompt repair but did not undergo surgery for a variety of reasons ("surgery noncompliant and overwhelming comorbidities'' group). Another 181 patients (24%) were triaged to medical management ("medical'' group). Results: In the "surgery noncompliant and overwhelming comorbidities'' versus the "medical'' group, mean aortic diameters were 5 +/- 0.5 cm versus 4.45 +/- 0.4 cm and aortic events (rupture/dissection) occurred in 17 patients (13.3%) versus 3 patients (1.7%), respectively (P < .001). Later elective surgeries (representing late compliance in the "surgery noncompliant and overwhelming comorbidities group'' or onset of growth or symptoms in the "medical'' group) were conducted in 21 patients (16.4%) versus 15 patients (8.3%) (P = .04), respectively. Death ensued in 20 patients (15.6%) versus 6 patients (3.3%) (P < .001), respectively. In the "surgery noncompliant and overwhelming comorbidities'' group, 7 of 20 patients died of definite aortic causes compared with none in the "medical'' group. Conclusions: Patients with ascending thoracic aortic aneurysms who did not follow surgical recommendations experienced substantially worse outcomes compared with medically triaged candidates. The specific algorithm based on size and symptoms functioned effectively in the clinical setting, correctly identifying both at-risk and safe patients.
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外文
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PubmedID：
中科院(CAS)分区：
出版当年[2018]版：
大类|2 区医学
小类|2 区呼吸系统2 区外科3 区心脏和心血管系统
最新[2023]版：
大类|1 区医学
小类|1 区外科2 区心脏和心血管系统2 区呼吸系统
JCR分区：
出版当年[2017]版：
Q1CARDIAC & CARDIOVASCULAR SYSTEMSQ1SURGERYQ1RESPIRATORY SYSTEM
第一作者机构：[a]Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn[b]Department of Internal Medicine, Saint Mary’s Hospital, Waterbury, Conn
通讯作者：
通讯机构：[a]Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn[*1]Aortic Institute at Yale-New Haven, Yale University School of Medicine, 789 Howard Ave, Clinic Building – CB317, New Haven, CT 06519
推荐引用方式(GB/T 7714)：
Ayman Saeyeldin,Mohammad A. Zafar,Yupeng Li ,et al.Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application?[J].JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY.2019,157(5):1733-1744.doi:10.1016/j.jtcvs.2018.09.124.
APA：
Ayman Saeyeldin,Mohammad A. Zafar,Yupeng Li,,Maryam Tanweer,Mohamed Abdelbaky...&John A. Elefteriades.(2019).Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application?.JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY,157,(5)
MLA：
Ayman Saeyeldin,et al."Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application?".JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 157..5(2019):1733-1744
医学