Fate of the unoperated ascending thoracic aortic aneurysm—patient selection and the importance of the denominator.

The article discusses a study on the natural history of unoperated ascending thoracic aortic aneurysms (TAA) conducted by the Aortic Institute at Yale University. The study found that among unoperated patients, there was an increased relative risk of adverse events when the aneurysm surpassed 5.0 cm, with overall slow aortic growth. However, the authors caution that the sample represents selected high-risk patients and may not capture the true rate of aortic dissection for all patients. They also highlight several limitations of the study, including excluded cohorts, inconsistent metrics, a mixed cohort, subjective outcomes, and discrepancies in event rates. The authors argue that clinical decision-making should be based on absolute risk and individualized to balance operative and surveillance risks. They look forward to further insights from the TITAN trial on the appropriate TAA size for intervention. [Extracted from the article]