{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:32:37Z","timestamp":1793226757945,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"43","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82200518"],"award-info":[{"award-number":["82200518"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,14]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study aims to outline the \u2018true\u2019 natural history of ascending thoracic aortic aneurysm (ATAA) based on a cohort of patients not undergoing surgical intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>The outcomes, risk factors, and growth rates of 964 unoperated ATAA patients were investigated, over a median follow-up of 7.9 (maximum of 34) years. The primary endpoint was adverse aortic events (AAE), including dissection, rupture, and aortic death. At aortic sizes of 3.5\u20133.9, 4.0\u20134.4, 4.5\u20134.9, 5.0\u20135.4, 5.5\u20135.9, and \u22656.0 cm, the average yearly risk of AAE was 0.2%, 0.2%, 0.3%, 1.4%, 2.0%, and 3.5%, respectively (P &amp;lt; 0.001), and the 10-year survival free from AAE was 97.8%, 98.2%, 97.3%, 84.6%, 80.4%, and 70.9%, respectively (P &amp;lt; 0.001). The risk of AAE was relatively flat until 5 cm of aortic size, at which it began to increase rapidly (P for non-linearity &amp;lt;0.001). The mean annual growth rate was estimated to be 0.10 \u00b1 0.01 cm\/year. Ascending thoracic aortic aneurysms grew in a very slow manner, and aortic growth over 0.2 cm\/year was rarely seen. Multivariable Cox regression identified aortic size [hazard ratio (HR): 1.78, 95% confidence interval (CI): 1.50\u20132.11, P &amp;lt; 0.001] and age (HR: 1.02, 95% CI: 1.00\u20131.05, P = 0.015) as significant independent risk factors for AAE. Interestingly, hyperlipidemia (HR: 0.46, 95% CI: 0.23\u20130.91, P = 0.025) was found to be a significant protective factor for AAE in univariable Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>An aortic size of 5 cm, rather than 5.5 cm, may be a more appropriate intervention criterion for prophylactic ATAA repair. Aortic growth may not be an applicable indicator for intervention.<\/jats:p><\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad148","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T23:03:29Z","timestamp":1677711809000},"page":"4579-4588","source":"Crossref","is-referenced-by-count":75,"title":["Fate of the unoperated ascending thoracic aortic aneurysm: three-decade experience from the Aortic Institute at Yale University"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2997-4565","authenticated-orcid":false,"given":"Jinlin","family":"Wu","sequence":"first","affiliation":[{"name":"Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine , 333 Cedar St, New Haven, CT 06510 , USA"},{"name":"Department of Cardiac Surgery, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial People\u2019s Hospital , 106 Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong 510060 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1666-199X","authenticated-orcid":false,"given":"Mohammad A","family":"Zafar","sequence":"additional","affiliation":[{"name":"Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine , 333 Cedar St, New Haven, CT 06510 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwei","family":"Liu","sequence":"additional","affiliation":[{"name":"Heart Center and Shanghai Institute of Pediatric Congenital Heart Diseases, Shanghai Children\u2019s Medical Center, Shanghai Jiao Tong University School of Medicine , 101 Tangqiao Beiyuan Road, Pudong New Area District, Shanghai 200127 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Fayanne","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toronto , 27 King's College Cir, Toronto, ON M5S , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2063-1067","authenticated-orcid":false,"given":"Yupeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Political Sciences and Economics, Rowan University , 201 Mullica Hill Rd, Glassboro, NJ 08028 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bulat A","family":"Ziganshin","sequence":"additional","affiliation":[{"name":"Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine , 333 Cedar St, New Haven, CT 06510 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8156-3336","authenticated-orcid":false,"given":"Hesham","family":"Ellauzi","sequence":"additional","affiliation":[{"name":"Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine , 333 Cedar St, New Haven, CT 06510 , 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