Aortic Dissection Clinical Trial
Official title:
An Investigation Into the Epidemiology and Surgical Intervention for Proximal Aortic Disease in Scotland
The aorta is the principal arterial vessel arising from the left heart that transfers blood to the body. Certain genetic and familial disease processes are known to weaken the aortic wall resulting in dilation and potential rupture. These aortic complications carry high mortality (>25%) and current management is orientated towards early detection and preventive treatment. Aortic dilation can also result in aortic valve dysfunction leading to heart failure. The estimated UK incidence of aortic disease per year is around 10 per 100,000 individuals, with 2000 people per year dying from aortic complications. The 2017-2020 National Adult Cardiac Surgery Audit report identified the number of people receiving surgery for aortic dissection in Scotland is per population proportionately lower compared to England (4.6 per million per year in Scotland vs. 6.6 per million per year in England). The reasons for this are unclear but may relate to the prevalence of aortic disease or a large geographic distribution with compromised access to specialized centres. Currently surgery is recommended when the aortic diameter exceeds a certain threshold. There are several types of effective surgical procedures, but there is still limited information on their long-term outcomes and the advantage of one procedure over another. The aims of the project are firstly to determine the clinical outcomes of the surgical procedures that are currently employed in Scotland to treat proximal aortic disease and secondly to describe the prevalence and distribution of proximal aortic disease within the Scottish population. The project will be hosted by the Golden Jubilee Research Institute. Contemporary and retrospective data will be collected from all the Scottish Cardiothoracic Surgery units which are based in Glasgow, Edinburgh and Aberdeen. This will be the first study to analyse surgical outcomes for ascending aortic disease in Scotland, and the first to describe the epidemiology of aortic disease within the population. It is anticipated that the results will guide current surgical practise, and provide data to inform national service provision for the management of proximal aortic disease.
Status | Not yet recruiting |
Enrollment | 2000 |
Est. completion date | August 2024 |
Est. primary completion date | August 2024 |
Accepts healthy volunteers | |
Gender | All |
Age group | 18 Years and older |
Eligibility | Surgical cohort Inclusion Criteria: - all adults (>18 years of age) that underwent surgical intervention on the proximal aorta in Scotland between 2008 and 2021. Exclusion Criteria: - Isolated surgery on the descending thoracic aorta Non-surgical cohort Inclusion Criteria: - all adult patients (>18 years of age) with a radiological, genetic or post-mortem diagnosis of thoracic aortic disease |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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Golden Jubilee National Hospital | Aberdeen Royal Infirmary, Network for Inherited Cardiac Conditions Scotland, Royal Infirmary of Edinburgh, University of Glasgow |
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Early survival following surgery of the proximal aorta | In-hospital or 30 days survival following surgery of the proximal aorta | In-hospital or 30 days (whichever is longer) | |
Primary | Late survival following surgery of the proximal aorta | Long-term survival following surgery of the proximal aorta | 5 years or latest available follow-up (whichever is longer) | |
Primary | Patient demographics and geographic distribution of thoracic aortopathy within the Scottish population | Identify the demographics (age, gender, relevant risk factors) and geographic distribution (area codes) of patients diagnosed with thoracic aortopathy within the Scottish population | Cross-sectional analysis (2011-2021) | |
Secondary | Cardiovascular reintervention | Reinterventions (surgical/endovascular) related to the aortic implant or unoperated aorta Reintervention on Aortic valve (native or prosthesis) | 1 year or latest available follow-up (whichever is longer) | |
Secondary | Specified adverse events following surgery | episodes of endocarditis, structural valve degeneration, thromboembolism, cerebral vascular accident, anticoagulant-related bleeding | 1 year or latest available follow-up (whichever is longer) | |
Secondary | Left ventricular ejection fraction (LVEF) following surgery | Long-term left ventricular ejection fraction (>50% - good, 31-50% - moderate, 21-30% - poor, 20% or less -very poor) as measured by echocardiography or cardiac MRI after surgery | 1 year or latest available follow-up (whichever is longer) | |
Secondary | Aortic valve mean gradient and degree of regurgitation following surgery | Long-term aortic valve function as assessed by mean gradient (mmHg) and degree of regurgitation (mild/moderate/severe) in operated patients assessed by echocardiography or cardiac MRI | 1 year or latest available follow-up (whichever is longer) | |
Secondary | Genotypes and phenotypes prevalent in the Scottish population | Identify genotypes and phenotypes in the Scottish population and assess their prevalence | Previous 5 years |
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