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Advances in aortic disease management: a year in review

Garg, Vinay; Ouzounian, Maral; Peterson, Mark D.

Current Opinion in Cardiology: March 2016 - Volume 31 - Issue 2 - p 127–131
doi: 10.1097/HCO.0000000000000267
VALVULAR HEART DISEASE: Edited by Subodh Verma
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Purpose of review The medical and surgical management of aortic disease is continually changing in search for improved outcomes. Our objective is to highlight recent advances in a few select areas pertaining to aortic disease and aortic surgery: the genetics of aortopathy, medical therapy of aortic aneurysms, advances in cardiac imaging, and operative strategies for the aortic arch.

Recent findings As our understanding of the genetic basis for aortopathy continues to improve, routine genetic testing may be of value in assessing patients with genetically triggered forms of aortic disease. With regard to medical advances, treating patients with Marfan syndrome with either losartan or atenolol at an earlier stage in their disease course improves outcomes. In addition, novel imaging indices such as wall shear stress and aortic stiffness assessed by MRI may become useful markers of aortopathy and warrant further study. With regard to the optimal technique for cerebral perfusion in aortic arch surgery, high-quality data are still lacking. Finally, in patients with complex, multilevel aortic disease, the frozen elephant trunk is a viable single-stage option compared with the conventional elephant trunk, although with an increased risk for spinal cord injury.

Summary Based on recent advances, continued studies in genetics, cardiac imaging, and surgical trials will further elucidate the etiology of aortopathy and ultimately guide management, both medically and surgically.

aDepartment of Internal Medicine

bDivision of Cardiac Surgery, Peter Munk Cardiac Centre

cDivision of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Correspondence to Mark D. Peterson, 30 Bond St, Toronto, ON M5B 1W8, Canada. Tel: +416 864 3086; e-mail: petersonm@smh.ca

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