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You can't always get what you want.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Coselli, Joseph S. |
| Copyright Year | 2019 |
| Abstract | YOU CAN’T ALWAYS GET WHAT YOU WANT Reply to the Editor: For patients with aortic dilatation who are free of symptoms, establishing the timing of aortic repair is the most crucial health decision they will likely face in their lifetimes. For their clinicians, the timing of repair is almost universally based on the aortic diameter. For most symptom-free patients with an aortic aneurysm, the threshold of repair is set at 5.5 cm or larger by contemporary practice guidelines. Depending on patient circumstances, the hinge point of repair may be lowered to between 4.0 cm and 5.0 cm. For patients with symptoms, surgery is warranted regardless of aortic diameter. In the study in this issue of the Journal by Saeyeldin and colleagues (including the senior author, Elefteriades), 781 patients with ascending aortic aneurysms were reviewed. In this study, they evaluated the impact of lowering the 5.5 cm diameter–based threshold for surgery to 5.0 cm or larger, in addition to further lowering that threshold to 4.0 cm in the presence of unexplained chest pain, strong family history, severe connective tissue disorder, or disease of a bicuspid aortic valve. Saeyeldin and colleagues found that when their algorithm was followed, the risk of 30-day death after ascending aortic replacement was an outstanding 1%. They found, however, that when their algorithm could not be followed (if comorbidities ruled out surgery or if the patient refused surgery), the risk of late aortic death or an aortic event was 12% or 13%, respectively. In addition, Saeyeldin and colleagues noted that in patients with aortic diameters between 4.0 cm and 4.9 cm who were without the specified risk factors, the likelihood of a late aortic risk factor dropped to 1% to 2%. The recent letter by Bugan and colleagues touches on the continuing controversy of how far to lower diameterbased thresholds of repair. The primary concern of Bugan and colleagues is how to treat the group of patients within the space between the existing (5.5 cm) and suggested (5.0 cm) hinge points. Further, Bugan and colleagues argue that the study conducted by Saeyeldin and colleagues could have evaluated their existing data better by using a different grouping strategy for patients in the study; Rather |
| File Format | PDF HTM / HTML |
| DOI | 10.1016/j.jtcvs.2019.05.077 |
| Alternate Webpage(s) | http://www.jtcvs.org/article/S0022522319311948/pdf |
| Alternate Webpage(s) | https://www.mbaresearch.org/newlaps/EC_6/EC6_st_PDF.pdf |
| PubMed reference number | 31279513 |
| Alternate Webpage(s) | https://doi.org/10.1016/j.jtcvs.2019.05.077 |
| Journal | Medline |
| Journal | The Journal of thoracic and cardiovascular surgery |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
