Histological pattern of non-infectious thoracic aortitis impacts mortality.

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Non-infectious aortitis encompasses various histological patterns, but their specific cardiovascular outcomes remain unclear. To evaluate the mortality associated with non-infectious surgical thoracic aortitis. This retrospective multicenter study included patients who underwent thoracic aortic surgery and had histological evidence of aortitis. The study analyzed the characteristics of patients with non-infectious aortitis presenting either a granulomatous/giant cell histological pattern or a lymphoplasmacytic pattern. Factors associated with mortality were identified using multivariate analysis. Among 5666 patients who underwent thoracic aortic surgery, 197 were found to have non-infectious aortitis with either a granulomatous/giant cell histological pattern (n=138) or a lymphoplasmacytic pattern (n=59). The overall standardized mortality rate (SMR) for patients with non-infectious surgical thoracic aortitis was 1.61 (95% CI: 1.05; 2.39), with 31.5% of patients dying within 10 years of the initial procedure. After a median follow-up of 3.5 years [IQR: 0.5-6.8] post-surgery, 31% of deaths were due to aortic dissection or rupture. The 10-year cumulative incidence of death was 40.1% (95% CI, 17.7-61.8) for patients with a granulomatous/giant cell pattern and 14.4% (95% CI, 2.6-35.6) for those with a lymphoplasmacytic pattern. Granulomatous/giant cell histological pattern (HR 4.71 [vs lymphoplasmacytic pattern]; 95% CI, 1.37-16.2; p=0.023) and aortic dissection at diagnosis (HR 6.07 [vs aneurysm]; 95% CI, 2.89-12.7; p<0.0001) were independently associated with increased mortality. This multicenter study found that 31.5% of patients with non-infectious surgical thoracic aortitis are expected to die within 10 years of their initial surgery. The granulomatous/giant cell histological pattern is associated with higher mortality.