Giant cell aortitis: clinical presentation and outcomes in 40 patients consecutively operated on

Gagné-Loranger, Maude; Dumont, Éric; Voisine, Pierre; Mohammadi, Siamak; Garceau, Claude; Dion, B.; Dagenais, François

doi:10.1093/ejcts/ezw041

Cited by 19 publications

(11 citation statements)

References 14 publications

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“…The risk of distal aortic disease was 11-fold in comparison to the control group [30]. The progressive aortic dilatation was noted in all levels from the arch to the infrarenal aorta after ascending aortic surgery [31].…”

Section: The Distal Aortamentioning

confidence: 83%

“…Aortic valve pathology was a positive predictor of inflammatory origin of the aneurysm in several studies [16][17][18]. Concomitant aortic valve surgery was performed in 51% and 80% of the patients [13,31] who had ascending aortic surgery for autoimmune aortitis. The aortic valve can be affected as a part of the systemic disease as in Cogan's syndrome and Behcet disease [41] while aortic valve affection in Takayasu is rare.…”

Section: The Aortic Valvementioning

confidence: 99%

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Surgery for autoimmune aortitis: unanswered questions

Arafat

2019

Cardiothorac Surg

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Background: The aorta is rarely affected by autoimmune vasculitis, which can lead to aortic dilatation requiring surgery. Autoimmune aortitis may affect one aortic segment or the entire aorta, and in some cases, the aorta may be affected at different time intervals. Because of the rarity of the disease and the limited cases described in the literature, management of autoimmune aortitis is still controversial. We aimed to review the current literature evidence regarding these controversial aspects for the management of autoimmune aortitis and give recommendations based on this evidence. Main text: Immunosuppressants are generally indicated in vasculitis to halt the progression of the disease; however, its role after the occurrence of aortic dilatation is debatable since further aortic dilatation would eventually occur because of the weakness of the arterial wall. In patients with a localized ascending aortic dilatation who required surgery, the optimal approach for the distal aorta is not known. If the probability of disease progression is high, it is not known whether the patients would benefit from postoperative immunosuppressants or further distal aortic intervention may be required. The risk of rupture of the weakened aortic wall was not established, and it is debatable at which diameter should these patients have surgery. In patients with previous ascending surgery for autoimmune aortitis, the endovascular management of the distal aortic disease has not been studied. The inflammatory process may extend to affect the aortic valve or the coronary vessels, which may require special attention during the procedure. Conclusion: Patients with diagnosed autoimmune aortitis are prone to the development of the distal aortic disease, and endovascular intervention is feasible in those patients. Patients with concomitant aortic valve can be managed with the aortic valve-sparing procedure, and preoperative screening for coronary disease is recommended. Immunosuppressants should be used early before aortic dilatation, and its role postoperatively is controversial.

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Section: The Distal Aortamentioning

confidence: 83%

Section: The Aortic Valvementioning

confidence: 99%

Surgery for autoimmune aortitis: unanswered questions

Arafat

2019

Cardiothorac Surg

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“…With the normal aortic valve cusps viewed macroscopically, valve-sparing root replacement could be indicated. 1,7,8) Gagné-Loranger et al reported that valve sparing was performed in 16 patients (50% of aortic valve procedure). One patient required an aortic valve replacement redo owing to a recurrent aortic regurgitation 4 years after the valve-sparing procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Gagné-Loranger et al cautioned that patients with GCA may be at increased risk for endoleaks, especially when the landing zone is diseased. 1) Reports of the anastomotic pseudoaneurysm in patients with GCA were scarce compared with Takayasu arteritis. However, patients with aneurysms by GCA carry an incidence of aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Giant cell aortitis (GCA) is an uncommon cause of thoracic aortic aneurysms, which often involve the aorta from the aortic root through the arch, extending to the thoracoabdominal aorta, the so-called mega-aortic syndrome (MAS). [1][2][3] We performed a two-stage hybrid repair, combining open and endovascular techniques, to treat MAS due to GCA in a heart failure patient with severe aortic regurgitation.…”

Section: Introductionmentioning

confidence: 99%

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Hybrid Repair for Mega-Aortic Syndrome due to Giant Cell Aortitis in a Heart Failure Patient

Inoue

Fujita

Kino

et al. 2020

Annals of Vascular Diseases

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The present report describes a case of mega-aortic syndrome accompanied with severe aortic regurgitation in a 75-year-old man who underwent a two-stage hybrid repair. Intraoperative pathologic findings at the first repair, consisting of Bentall operation and total arch replacement with a Lupiae graft, aided the identification of the giant cell aortitis. Despite complicating hemorrhagic stroke, steroid therapy was initiated and endovascular repair was subsequently completed. Over more than 2 years of follow-up, the patient continued steroid therapy and is doing well without any reintervention.

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