Surgical Treatment of Patients Enrolled in the National Registry of Genetically Triggered Thoracic Aortic Conditions

• Published in: The Annals of thoracic surgery Vol. 88; no. 3; pp. 781 - 788
• Main Authors: Song, Howard K., MD, PhD, Bavaria, Joseph E., MD, Kindem, Mark W., MS, Holmes, Kathryn W., MD, Milewicz, Dianna M., MD, PhD, Maslen, Cheryl L., PhD, Pyeritz, Reed E., MD, PhD, Basson, Craig T., MD, PhD, Eagle, Kim, MD, Tolunay, H. Eser, PhD, Kroner, Barbara L., PhD, Dietz, Hal, MD, PhD, Menashe, Victor, MD, Devereux, Richard B., MD, Desvigne-Nickens, Patrice, MD, Ravekes, William, MD, Weinsaft, Jonathan W., MD, Brambilla, Donald, PhD, Stylianou, Mario P., PhD, Hendershot, Tabitha, BA, Mitchell, Megan S., MPH, LeMaire, Scott A., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.09.2009
• Subjects: Adolescent; Adult; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - genetics; Aortic Aneurysm, Thoracic - surgery; Aortic Diseases - genetics; Aortic Diseases - surgery; Aortic Dissection - genetics; Aortic Dissection - surgery; Aortic Valve - abnormalities; Aortic Valve - surgery; Blood Vessel Prosthesis Implantation; Cardiothoracic Surgery; Female; Hospitals, University; Humans; Longitudinal Studies; Male; Marfan Syndrome - genetics; Marfan Syndrome - surgery; Middle Aged; Multicenter Studies as Topic; Postoperative Complications - surgery; Registries; Reoperation; Surgery; Syndrome; United States; Young Adult; United States; 26
• ISSN: 0003-4975; 1552-6259; 1552-6259
• DOI: 10.1016/j.athoracsur.2009.04.034

Background Genetic disorders are an important cause of thoracic aortic aneurysms (TAAs) in young patients. Despite advances in the treatment of genetically triggered TAAs, the optimal syndrome-specific treatment approach remains undefined. We used data from the National Institutes of Health–funded, multicenter National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) to characterize the contemporary surgical treatment of patients with genetically triggered TAAs. Methods GenTAC's aim is to collect longitudinal clinical data and banked biospecimens from 2800 patients with genetically triggered TAAs. We analyzed data from the 606 patients (mean age, 37.5 years) enrolled in GenTAC to date whose clinical data were available. Results The patients' primary diagnoses included Marfan syndrome (35.8%), bicuspid aortic valve with aneurysm (29.2%), and familial TAAs and dissections (10.7%). Of these, 56.4% had undergone at least one operation; the most common indications were aneurysm (85.7%), valve dysfunction (65.8%), and dissection (25.4%). Surgical procedures included replacement of the aortic root (50.6%), ascending aorta (64.8%), aortic arch (27.9%), and descending or thoracoabdominal aorta (12.4%). Syndrome-specific differences in age, indications for operation, and procedure type were identified. Conclusions Patients with genetically transmitted TAAs evaluated in tertiary care centers frequently undergo surgical repair. Aneurysm repairs most commonly involve the aortic root and ascending aorta; distal repairs are less common. Like TAAs themselves, complications of TAAs, including dissection and aortic valve dysfunction, are important indications for intervention. Future studies will focus on syndrome- and gene-specific phenotypes, biomarkers, treatments, and outcomes to improve the treatment of patients with TAAs.