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Solomon MD, Leong T, Sung SH, Lee C, Allen JG, Huh J, LaPunzina P, Lee H, Mason D, Melikian V, Pellegrini D, Scoville D, Sheikh AY, Mendoza D, Naderi S, Sheridan A, Hu X, Cirimele W, Gisslow A, Leung S, Padilla K, Bloom M, Chung J, Topic A, Vafaei P, Chang R, Miller DC, Liang DH, Go AS. Association of Thoracic Aortic Aneurysm Size With Long-term Patient Outcomes: The KP-TAA Study. JAMA Cardiol 2022; 7:1160-1169. [PMID: 36197675 PMCID: PMC9535537 DOI: 10.1001/jamacardio.2022.3305] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
Importance The risk of adverse events from ascending thoracic aorta aneurysm (TAA) is poorly understood but drives clinical decision-making. Objective To evaluate the association of TAA size with outcomes in nonsyndromic patients in a large non-referral-based health care delivery system. Design, Setting, and Participants The Kaiser Permanente Thoracic Aortic Aneurysm (KP-TAA) cohort study was a retrospective cohort study at Kaiser Permanente Northern California, a fully integrated health care delivery system insuring and providing care for more than 4.5 million persons. Nonsyndromic patients from a regional TAA safety net tracking system were included. Imaging data including maximum TAA size were merged with electronic health record (EHR) and comprehensive death data to obtain demographic characteristics, comorbidities, medications, laboratory values, vital signs, and subsequent outcomes. Unadjusted rates were calculated and the association of TAA size with outcomes was evaluated in multivariable competing risk models that categorized TAA size as a baseline and time-updated variable and accounted for potential confounders. Data were analyzed from January 2018 to August 2021. Exposures TAA size. Main Outcomes and Measures Aortic dissection (AD), all-cause death, and elective aortic surgery. Results Of 6372 patients with TAA identified between 2000 and 2016 (mean [SD] age, 68.6 [13.0] years; 2050 female individuals [32.2%] and 4322 male individuals [67.8%]), mean (SD) initial TAA size was 4.4 (0.5) cm (828 individuals [13.0% of cohort] had initial TAA size 5.0 cm or larger and 280 [4.4%] 5.5 cm or larger). Rates of AD were low across a mean (SD) 3.7 (2.5) years of follow-up (44 individuals [0.7% of cohort]; incidence 0.22 events per 100 person-years). Larger initial aortic size was associated with higher risk of AD and all-cause death in multivariable models, with an inflection point in risk at 6.0 cm. Estimated adjusted risks of AD within 5 years were 0.3% (95% CI, 0.3-0.7), 0.6% (95% CI, 0.4-1.3), 1.5% (95% CI, 1.2-3.9), 3.6% (95% CI, 1.8-12.8), and 10.5% (95% CI, 2.7-44.3) in patients with TAA size of 4.0 to 4.4 cm, 4.5 to 4.9 cm, 5.0 to 5.4 cm, 5.5 to 5.9 cm, and 6.0 cm or larger, respectively, in time-updated models. Rates of the composite outcome of AD and all-cause death were higher than for AD alone, but a similar inflection point for increased risk was observed at 6.0 cm. Conclusions and Relevance In a large sociodemographically diverse cohort of patients with TAA, absolute risk of aortic dissection was low but increased with larger aortic sizes after adjustment for potential confounders and competing risks. Our data support current consensus guidelines recommending prophylactic surgery in nonsyndromic individuals with TAA at a 5.5-cm threshold.
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Affiliation(s)
- Matthew D. Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Thomas Leong
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - J. Geoff Allen
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Joseph Huh
- Department of Cardiothoracic Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Paul LaPunzina
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Hon Lee
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Duncan Mason
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Vicken Melikian
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Daniel Pellegrini
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - David Scoville
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Ahmad Y. Sheikh
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Dorinna Mendoza
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Sahar Naderi
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Ann Sheridan
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Xinge Hu
- Department of Cardiology, Kaiser Permanente Fremont Medical Center, Fremont, California
| | - Wendy Cirimele
- Department of Cardiothoracic Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Anne Gisslow
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Sandy Leung
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Kristine Padilla
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Michael Bloom
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Josh Chung
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Adrienne Topic
- Department of Cardiology, WellSpan Health Good Samaritan Hospital, Lebanon, Pennsylvania
| | - Paniz Vafaei
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Robert Chang
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - D. Craig Miller
- Department of Cardiovascular Surgery, Stanford University School of Medicine, Stanford, California
| | - David H. Liang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Department of Epidemiology, University of California, San Francisco
- Department of Biostatistics, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
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Roberts WC, Siddiquiz S, Rafael-Yarihuaman AE, Roberts CS. Management of Adults With Normally Functioning Congenitally Bicuspid Aortic Valves and Dilated Ascending Aortas. Am J Cardiol 2020; 125:157-160. [PMID: 31718787 DOI: 10.1016/j.amjcard.2019.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
We describe herein a 65-year-old woman who underwent resection of a dilated (5.1 cm) ascending aorta associated with a normally functioning congenitally bicuspid aortic valve. The patient provided the framework to discuss proper management-operative versus nonoperative-of the dilated ascending aorta associated with a normally functioning bicuspid aortic valve. Unfortunately, there is inadequate data to provide an unequivocal answer to this dilemma. Operative intervention requires that the short-term risk of the prophylactic procedure be considerably lower than the long-term risk of aortic dissection/rupture without operative intervention. Because there is no proof that operative intervention provides less morbidity and lower mortality, nonoperative management at this time seems to be the better approach.
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Mastrobuoni S, de Kerchove L, Navarra E, Watremez C, Vancraeynest D, Rubay J, Noirhomme P, El Khoury G. Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation. J Thorac Cardiovasc Surg 2019; 158:14-23. [DOI: 10.1016/j.jtcvs.2018.10.155] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/12/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022]
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Fatehi Hassanabad A, Feindel CM, Verma S, Fedak PWM. Evolving Surgical Approaches to Bicuspid Aortic Valve Associated Aortopathy. Front Cardiovasc Med 2019; 6:19. [PMID: 30886849 PMCID: PMC6409296 DOI: 10.3389/fcvm.2019.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/13/2019] [Indexed: 01/06/2023] Open
Abstract
Bicuspid aortic valve (BAV) is the most common congenital cardiac pathology which results from the fusion of two adjacent aortic valve cusps. It is associated with dilatation of the aorta, known as bicuspid valve-associated aortopathy or bicuspid aortopathy. Bicuspid aortopathy is progressive and is linked with adverse clinical events. Hence, frequent monitoring and early intervention with prophylactic surgical resection of the proximal aorta is often recommended. Over the past two decades resection strategies and surgical interventions have mainly been directed by surgeon and institution preferences. These practices have ranged from conservative to aggressive approaches based on aortic size and growth criteria. This strategy, however, may not best reflect the risks of important aortic events. A new set of guidelines was proposed for the treatment of bicuspid aortopathy. Herein, we will highlight the most recent findings pertinent to bicuspid aortopathy and its management in the context of a case presentation.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Christopher M Feindel
- Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, Toronto, ON, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.,Martha and Richard Melman Family Bicuspid Aortic Valve Program, Division of Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, United States
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Descending threshold for ascending aortic aneurysmectomy: Is it time for a “left-shift” in guidelines? J Thorac Cardiovasc Surg 2019; 157:37-42. [DOI: 10.1016/j.jtcvs.2018.07.114] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/13/2018] [Accepted: 07/27/2018] [Indexed: 12/20/2022]
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6
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Hui SK, Fan CPS, Christie S, Feindel CM, David TE, Ouzounian M. The aortic root does not dilate over time after replacement of the aortic valve and ascending aorta in patients with bicuspid or tricuspid aortic valves. J Thorac Cardiovasc Surg 2018; 156:5-13.e1. [PMID: 29656818 DOI: 10.1016/j.jtcvs.2018.02.094] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 02/06/2018] [Accepted: 02/25/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Whether the aortopathy associated with bicuspid aortic valve (BAV) disease occurs secondary to genetic or hemodynamic factors remains controversial. In this article we describe the natural history of the aortic root in patients with bicuspid versus tricuspid aortic valves (TAVs) after replacement of the aortic valve and ascending aorta. METHODS From 1990 to 2010, 406 patients (269 BAV, 137 TAV) underwent aortic valve and ascending aorta replacement at a single institution. Patients with aortic dissection, endocarditis, previous aortic surgery, or Marfan syndrome were excluded. All available follow-up imaging was reviewed. RESULTS Mean imaging follow-up was 5.5 (±5.3) years. Of all patients, 66.5% had at least 1 aortic root measurement after the index operation. Baseline aortic diameter was comparable between groups. In patients with BAV, aortic root diameter increased at a clinically negligible rate over time (0.654 mm per year; 95% confidence interval, 0.291-1.016; P < .001), similar to patients with TAV (P = .92). Mean clinical follow-up was 8.1 (±5.4) years. During follow-up, 18 patients underwent reoperation, 89% for a degenerated bioprosthetic aortic valve. Only 1 patient underwent reoperation for a primary indication of aortic aneurysmal disease, 22 years after the index operation. There were no differences in cumulative incidence rates of aortic reoperation (P = .14) between patients with BAV and TAV. CONCLUSIONS Mid-term imaging after aortic valve and ascending aorta replacement indicates that if the aortic root is not dilated at the time of surgery, the risk of enlargement over time is minimal, negating the need for prophylactic root replacement in patients with BAV or TAV.
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Affiliation(s)
- Sonya K Hui
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Chun-Po Steve Fan
- Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shakira Christie
- Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M Feindel
- Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tirone E David
- Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
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Dilatación de arco aórtico en la aortopatía asociada a válvula aórtica bicúspide: factores predictivos y seguimiento a medio plazo. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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8
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Kwon MH, Sundt TM. Bicuspid Aortic Valvulopathy and Associated Aortopathy: a Review of Contemporary Studies Relevant to Clinical Decision-Making. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:68. [DOI: 10.1007/s11936-017-0569-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Pasta S, Gentile G, Raffa G, Bellavia D, Chiarello G, Liotta R, Luca A, Scardulla C, Pilato M. In Silico Shear and Intramural Stresses are Linked to Aortic Valve Morphology in Dilated Ascending Aorta. Eur J Vasc Endovasc Surg 2017; 54:254-263. [DOI: 10.1016/j.ejvs.2017.05.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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10
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Fatehi Hassanabad A, Barker AJ, Guzzardi D, Markl M, Malaisrie C, McCarthy PM, Fedak PWM. Evolution of Precision Medicine and Surgical Strategies for Bicuspid Aortic Valve-Associated Aortopathy. Front Physiol 2017; 8:475. [PMID: 28740468 PMCID: PMC5502281 DOI: 10.3389/fphys.2017.00475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022] Open
Abstract
Bicuspid aortic valve (BAV) is a common congenital cardiac malformation affecting 1–2% of people. BAV results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as bicuspid valve associated aortopathy. Bicuspid valve aortopathy is progressive and associated with catastrophic clinical events, such as aortic dissection and rupture. Therefore, frequent monitoring and early intervention with prophylactic surgical resection of the proximal aorta is often recommended. However, the specific pattern of aortopathy is highly variable among patients, with different segments of the ascending aorta being affected. Individual patient risks are sometimes difficult to predict. Resection strategies are informed by current surgical guidelines which are primarily based on aortic size and growth criteria. These criteria may not optimally reflect the risk of important aortic events. To address these issues in the care of patients with bicuspid valve aortopathy, our translational research group has focused on validating use of novel imaging techniques to establish non-invasive hemodynamic biomarkers for risk-stratifying BAV patients. In this article, we review recent efforts, successes, and ongoing challenges in the development of more precise and individualized surgical approaches for patients with bicuspid aortic valves and associated aortic disease.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of CalgaryCalgary, AB, Canada
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, United States
| | - David Guzzardi
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of CalgaryCalgary, AB, Canada
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, United States.,Department of Bioengineering, Feinberg School of Medicine, Northwestern UniversityChicago, IL, United States
| | - Chris Malaisrie
- Martha and Richard Melman Family Bicuspid Aortic Valve Program, Division of Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern UniversityChicago, IL, United States
| | - Patrick M McCarthy
- Martha and Richard Melman Family Bicuspid Aortic Valve Program, Division of Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern UniversityChicago, IL, United States
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of CalgaryCalgary, AB, Canada.,Martha and Richard Melman Family Bicuspid Aortic Valve Program, Division of Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern UniversityChicago, IL, United States
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11
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Comprehensive 4-stage categorization of bicuspid aortic valve leaflet morphology by cardiac MRI in 386 patients. Int J Cardiovasc Imaging 2017; 33:1213-1221. [DOI: 10.1007/s10554-017-1107-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/02/2017] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW This article outlines the key research contribution to bicuspid aortic valve (BAV) aortopathy over the past 18 months. RECENT FINDINGS Investigators have further defined the current gaps in knowledge and the scope of the clinical problem of BAV aortopathy. Support for aggressive resection strategies is waning as evidence mounts to suggest that BAV is not similar to genetic connective tissue disorders with respect to aortic risks. The role of cusp fusion patterns and valve-mediated hemodynamics in disease progression is a major area of discovery. Molecular and cellular mechanisms remain elusive and contradictory. SUMMARY BAV aortopathy is a major public health problem that remains poorly understood. New insights on valve-mediated hemodynamics using novel imaging modalities may lead to more individualized resection strategies and improved clinical guidelines.
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Affiliation(s)
- Paul W M Fedak
- aDepartment of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary bDivision of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Canada cDepartment of Radiology, Northwestern University dDivision of Surgery - Cardiac Surgery, Bluhm Cardiovascular Institute, Chicago, USA
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Kim JB, Spotnitz M, Lindsay ME, MacGillivray TE, Isselbacher EM, Sundt TM. Risk of Aortic Dissection in the Moderately Dilated Ascending Aorta. J Am Coll Cardiol 2016; 68:1209-1219. [DOI: 10.1016/j.jacc.2016.06.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 01/15/2023]
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Fedak PWM, Barker AJ. Is Concomitant Aortopathy Unique With Bicuspid Aortic Valve Stenosis? J Am Coll Cardiol 2016; 67:1797-1799. [PMID: 27081019 DOI: 10.1016/j.jacc.2016.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois.
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, Illinois
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Raffa GM, Wu B, Pasta S, Morsolini M, Bellavia D, Romano G, Falletta C, Pietrosi A, Scardulla C, Pilato M. Patients with bicuspid aortic valve are likely to receive an aortic valve prosthesis during prophylactic resection of their ascending aortic aneurysm. Int J Cardiol 2016; 206:97-100. [PMID: 26785033 DOI: 10.1016/j.ijcard.2016.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/25/2015] [Accepted: 01/01/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
| | - Bryan Wu
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | | | - Marco Morsolini
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Giuseppe Romano
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Calogero Falletta
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Astrid Pietrosi
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Cesare Scardulla
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
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