Ascending aortic disease: is current general perception updated to current guidelines ??

Abstract Backgroud Thoracic aorta diseases represent a frequent cause of hospitalization and up to 15% of workload of a modern Cardiac Surgery centre. To allow for an accurate monitoring of such activity a dedicated thoracic aorta diseases clinic was launched in January 2019 at our Division. Clinic was open for all new referrals (both by general pratictioner and different specialities clinic) as well as for follow–up of operated on patients. Here we report our analysis of new referrals during past 30 months. Materials and Metods 237 overall patients were seen at clinic. 68 patients (29%) were new referrals; 23 patients (10%) were preoperative follow up and 145 (61%) were postoperative follow up. New referrals were divided in urgent referral (42 pts 62%) and scheduled referral (26 patients 38%). Out of 168 follow up, 22 (12%) were requested as urgent follow up. Majority of urgent new referral were from general pratictioner (21 pts 50%). Results Only 5 patients (2 urgent referral) had surgical indication at time of clinic assessment, according current guidelines. 23 patients (6 urgent referral) were in the so–called grey zone and required close follow–up). 40 patients (34 urgent referral) had no significant aortic diseases to require neither urgent specialist consultation or close follow–up. Out of 181 postoperative follow up, 12 patients required surgical re–intervention none of these were referred with matter of urgency. Despite 56% of new referral did not have recent CT scan evaluation, majority of new referral clearly showed moderate aortic dilatation especially in urgent referral (Fig 1). When considering indexed–dilatation, proportion of patient with moderate dilation raised even more (Fig 2). Conclusions Current perception of clinical severity of thoracic aorta diseases is still sub–optimal. Majority of patients are indeed referred as a matter of urgency despite non–significant aortic ectasia. On other hands, potentially dangerous situation are underestimated by the general practitioner and/or medical specialist. An accurate territorial policy of sensitization and updating about these pathologies is therefore essential to try to reduce the risks of acute aortic syndromes in our country.