{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T02:02:17Z","timestamp":1793152937074,"version":"4.5.0"},"reference-count":23,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,5,10]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ascending thoracic aortic aneurysm (ATAA) is an asymptomatic condition that can lead to catastrophic events of rupture or dissection. Current guidelines are based on limited retrospective data and recommend surgical intervention for ATAA with a diameter of greater or equal to 5.5\u2009cm. Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance is the first prospective, multicentre, randomised controlled trial that compares outcomes of patients undergoing early elective ascending aortic surgery to patients undergoing medical surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Patients between the ages of 18 and 80 with an asymptomatic ATAA between 5.0\u2009cm and 5.4\u2009cm in diameter are eligible for randomisation to early surgery or surveillance. Patients in the surgery group will be followed at 1\u2009month after discharge, then annually for a minimum of 2 years and up to 5 years. Patients in the surveillance group will be followed annually from their index clinic visit for a minimum of 2 years and up to 5 years. The primary outcome is all-cause mortality at follow-up. A sample size of 618 subjects (309 in each group) will achieve an 80% power at a 0.047 significance level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has received Ottawa Health Science Network Research Ethics Board approval (Protocol 20180007-01H), which was most recently updated on 25 November 2020. The Research Ethics Board have granted approval to the study at 14 participating institutions, including the Ottawa Health Science Network Research Ethics Board. On completion of data analysis, the result of the trial will be presented at national and international conferences, and published in relevant journals, regardless of the finding of the trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03536312\">NCT03536312<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052070","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T14:38:45Z","timestamp":1622039925000},"page":"e052070","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Protocol for a randomised controlled trial for Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance (TITAN: SvS)"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct03536312","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ming Hao","family":"Guo","sequence":"first","affiliation":[{"name":"Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehangir J","family":"Appoo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A","family":"Wells","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Chu","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maral","family":"Ouzounian","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Fortier","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-8697","authenticated-orcid":false,"given":"Munir","family":"Boodhwani","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"key":"2025121410450105000_11.5.e052070.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.7.897"},{"key":"2025121410450105000_11.5.e052070.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.029"},{"key":"2025121410450105000_11.5.e052070.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)03236-2"},{"key":"2025121410450105000_11.5.e052070.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3181d4739e"},{"key":"2025121410450105000_11.5.e052070.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu281"},{"key":"2025121410450105000_11.5.e052070.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2014.02.018"},{"key":"2025121410450105000_11.5.e052070.7","first-page":"703","article-title":"Canadian cardiovascular Society\/Canadian Society of cardiac Surgeons\/Canadian Society for vascular surgery joint position statement on open and endovascular surgery for thoracic aortic disease","volume":"32","author":"Appoo","year":"2016","journal-title":"Can J Cardiol"},{"key":"2025121410450105000_11.5.e052070.8","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2018.1281","article-title":"Association of mortality and acute aortic events with ascending aortic aneurysm: a systematic review and meta-analysis","volume":"1","author":"Guo","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2025121410450105000_11.5.e052070.9","unstructured":"Mori M , Shioda K , Wang X , Fort Lauderdale . 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