431 Very Long Term Follow-Up (>3000 Days) of Aortopathy Patients - Surgical Intervention/Dissection is Predicted by Accelerated Annualised Aortic Growth Rate

Abstract

Very long term follow-up data and rates of progressive aortic dilatation for patients with aortopathy with prediction of events is lacking in the literature. We performed analysis of aortic growth rates in a cohort of patients with known or suspected aortopathy followed for 4-15 years. Patients referred to our aortopathy clinic with a minimum follow-up period of 1460 days from initial digital transthoracic echocardiogram (TTE) were included for analysis. Aortic dilatation was defined as any measurement >36mm and/or >20mm/m2. Sequential measurements were compared between patients with surgery/dissection (n=18) and those with no events (n=80). The average follow-up was 8±3.1 yrs. Mean age was 53.5±19.8 yrs (71% male). The 18 surgery/dissection patients (43±15 yrs), 16 had aortic surgery, 1 Type B dissection, and 1 death from Type A dissection, with an annual rate of growth of sinotubular junction (STJ 0.7mm±1.0mm/yr) and ascending aorta (AscAo 0.7±1.2mm/yr). Patients with no surgery/dissection were significantly older (55±20yrs, p=0.01), with significantly slower rates of progression (STJ 0.3mm±0.4mm/yr, p=0.006; AscAo 0.3±0.3mm/yr, p=0.004). The annual growth of the trans-sinus dimension was not statistically significant, however, in the surgical group the dimension at initial TTE was significantly greater (45±4mm vs 39±4mm, p<0.001). In very long term follow-up most patients with aortopathy demonstrate extremely slow rates of expansion. Elective surgery and dissection are manifest in patients with significantly more rapid rates of progression. These data may allow customisation of surveillance protocols in individual patients in the future.