Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis

Prasad, Anjali; Helder, Meghana R.K.; Lahr, Brian D.; Dearani, Joseph A.; Greason, Kevin L.; Pochettino, Alberto; Warrington, Kenneth J.; Connolly, Heidi M.; Anavekar, Nandan S.; Schaff, Hartzell V.

doi:10.1016/j.athoracsur.2018.01.009

Cited by 1 publication

(6 citation statements)

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“…Although it is possible some rheumatology visits may have been missing in this database, a similarly low rate of referral to a rheumatologist was observed during hospitalization and at discharge (in which there were no missing data). Our findings contrast with a study of a surgical cohort of nearly 200 patients with aortitis at the Mayo Clinic by Prasad et al in which 61% of surviving patients had a rheumatologist actively participate in their care ( 15 ). This difference might reflect regional or hospital‐level variations in practice.…”

Section: Discussioncontrasting

confidence: 99%

“…One major strength of this study was that it assessed only those patients who were incidentally found to have aortitis after their index surgery, a unique clinical situation encountered by rheumatologists. Many prior studies on aortitis included patients with known systemic vasculitis or other rheumatologic disease who may have already been on perioperative immunosuppression and seeing a rheumatologist, something that could very well skew short‐ and long‐term postoperative outcomes in those cohorts ( 3 , 15 , 16 ). Another strength of this study was the inclusion of a relatively large number of patients with aortitis as well as matched noninflammatory comparators, which allowed for better risk assessment associated with aortitis.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies evaluating outcomes of CIA after surgical repair have demonstrated high rates of surgical revision and new vascular lesions. However, these studies were case series limited by small sample size or lack of a noninflammatory comparator group ( 5 , 8 , 10 , 12 , 13 , 14 , 15 , 16 ). Because surgical revision or new vascular lesions (eg, due to atherosclerosis) can occur in patients without vasculitis, understanding the additional risk of these outcomes in aortitis would inform management, particularly ongoing surveillance and immunosuppressive therapies.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Because surgical revision or new vascular lesions (eg, due to atherosclerosis) can occur in patients without vasculitis, understanding the additional risk of these outcomes in aortitis would inform management, particularly ongoing surveillance and immunosuppressive therapies. Furthermore, prior studies have had conflicting results regarding glucocorticoid treatment and future risk of reoperation or radiographic progression of vascular disease (5,8,10,(13)(14)(15). The goal of this study was to examine the immediate postoperative and long-term outcomes of patients with noninfectious CIA compared to patients with noninflammatory aortic aneurysms after undergoing open thoracic aortic aneurysm repair.…”

Section: Introductionmentioning

confidence: 99%

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Long‐Term Clinical and Radiographic Outcomes in Patients With Clinically Isolated Aortitis

Mayer

Sperry

Quimson

et al. 2022

ACR Open Rheumatology

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Objective The optimal management of patients with incidentally found clinically isolated aortitis (CIA) after aneurysm repair is unclear. This study compared long‐term surgical and clinical outcomes after surgical repair of thoracic aortic aneurysm between patients with CIA and patients with noninflammatory etiologies. Methods This is a matched cohort study. Patients with CIA were identified by histopathology following open thoracic aortic aneurysm repair. Two comparators without inflammation on pathology were matched to each patient by year of surgical repair. Outcomes included surgical complications, new vascular abnormalities on imaging, and death. Results One hundred sixty‐two patients were included: 53 with CIA and 109 matched comparators. Median follow‐up time was similar between groups (CIA 3.7 vs. comparator 3.3 years, P = 0.64). There was no difference in postoperative complications, surgical revision, or death between groups. Only 32% of patients with CIA saw a rheumatologist in the outpatient setting and 33% received immunosuppressive treatment. On surveillance imaging, no difference was seen in new or worsening aortic aneurysms, but there were significantly more vascular abnormalities in branch arteries of the thoracic aorta in patients with CIA (39% vs. 11%, P < 0.01). Conclusion Among patients who underwent surgical repair of a thoracic aortic aneurysm, patients with CIA were more likely than noninflammatory comparators to develop radiographic abnormalities in aortic branch arteries. Notably, there was no difference in risk of new aortic aneurysms or surgical complications despite most patients with CIA never receiving immunosuppression. This suggests that more selective initiation of immunosuppression in CIA may be considered after aortic aneurysm repair.

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Section: Discussioncontrasting

confidence: 99%