Growth of the Descending Thoracic Aorta Following Ascending Thoracic Aortic Surgery
Nicolai P. Ostberg, M.S., Mohammad A. Zafar, M.B.B.S., John A. Elefteriades, M.D..
The Aortic Institute at Yale-New Haven Hospital, New Haven, CT, USA.
OBJECTIVE: Replacing a native biological aorta with a stiff artificial graft may alter pressure wave forms and impact the residual descending aorta. We aim to determine if the growth rate of the descending thoracic aorta (DTA) changes following ascending thoracic replacement.
METHODS: Patients with at least two measurements of their DTA after ascending thoracic surgery were matched 1:1 to patients who did not undergo descending thoracic surgery with at least two DTA measurements. Patients were propensity score matched based on age, gender, hypertension, smoking history, dyslipidemia, and initial ascending thoracic diameter with calipers of 0.1. Any patient that eventually underwent descending thoracic surgery or who had an DTA > 4 cm at the start of the study were excluded. A multivariate conditional logistic regression was then performed to examine the association between ascending aortic surgery and descending thoracic growth rate.
RESULTS: Of the 1406 patients who underwent ascending thoracic surgery in our institutional database, 223 patients met the inclusion criteria. An additional 241 controls were identified from the same database. 139 patients were subsequently matched between both groups. The median growth rate of the descending aorta for post-surgical patients was 0.48 mm/y (IQR, 0.0, 1.33) compared to 0.41 mm/y (IQR, 0.0, 1.22) for non-surgical patients (Figure 1). After adjusting for confounding covariates, this difference in growth rates was not statistically significant (adjusted OR, 1.01, 95% CI, 0.89, 1.15, p-value, 0.90)
CONCLUSIONS: DTA growth rate does not appear to be significantly increased by potential hemodynamic changes from ascending thoracic surgery.
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