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Variants of the Aortic Arch in Adult General Population and their Association with Thoracic Aortic Aneurysm Disease
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  • Sameh Yousef,
  • saket singh,
  • Abedalrazaq AlKukhun,
  • Bilal Alturkmani,
  • Makoto Mori,
  • Julia Chen,
  • Clancy Mullan,
  • Cornell Brooks,
  • Roland Assi,
  • Peter Gruber,
  • Isabel Cortopassi,
  • Arnar Geirsson,
  • Prashanth Vallabhajosyula
Sameh Yousef
Yale School of Medicine
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saket singh
Yale University School of Medicine
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Abedalrazaq AlKukhun
Yale University School of Medicine
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Bilal Alturkmani
Yale University School of Medicine
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Makoto Mori
Yale University School of Medicine
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Julia Chen
Yale-New Haven Hospital
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Clancy Mullan
Yale School of Medicine
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Cornell Brooks
Yale School of Medicine
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Roland Assi
Yale University School of Medicine
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Peter Gruber
Yale University School of Medicine
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Isabel Cortopassi
Yale University School of Medicine
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Arnar Geirsson
Yale University School of Medicine
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Prashanth Vallabhajosyula
Yale School of Medicine
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Abstract

Background. Query a single institution computed tomography (CT) database to assess the prevalence of aortic arch anomalies in general adult population and their potential association with thoracic aortopathies. Methods. CT chest scan reports of patients aged 50-85 years old performed for any indication at a single health system between 2013 and 2016 were included in the analysis. Characteristics of patients with and without aortic arch anomalies were compared by t-test and Fisher exact tests. Logistic regression analysis was performed to assess for independent risk factors of thoracic aortic aneurysm. Results. Of 21,336 CT scans, 603 (2.8%) described arch anomalies. Bovine arch (n=354, 58.7%) was the most common diagnosis. Patients with arch anomalies were more likely to be female (p<0.001), non-Caucasian(p<0.001), and hypertensive (p<0.001). Prevalence of thoracic aortic aneurysm in arch anomalies group was 10.8% (n=65) compared to 4.1% (n=844) in the non-arch anomaly cohort (p<0.001). The highest prevalence of thoracic aneurysm was associated with right-sided arch combined with aberrant left subclavian configuration (33%), followed by bovine arch (13%), and aberrant right subclavian artery (8.2%). On binary logistic regression, arch anomaly (OR=2.85 [2.16-3.75]), aortic valve pathology (OR 2.93 [2.31-3.73]), male sex (OR 2.38 [2.01-2.80]), and hypertension (OR 1.47 [1.25-1.73]) were significantly associated with increased risk of thoracic aneurysm disease. Conclusions. Reported prevalence of aortic arch anomalies by CT imaging in the older adult population is ~3%, with high association of thoracic aortic aneurysm (OR=2.85) incidence in this subgroup. This may warrant a more tailored surveillance strategy for aneurysm disease in this subpopulation.

Peer review status:ACCEPTED

02 Jan 2021Submitted to Journal of Cardiac Surgery
04 Jan 2021Submission Checks Completed
04 Jan 2021Assigned to Editor
04 Jan 2021Reviewer(s) Assigned
27 Jan 2021Review(s) Completed, Editorial Evaluation Pending
27 Jan 2021Editorial Decision: Revise Minor
23 Feb 20211st Revision Received
26 Feb 2021Submission Checks Completed
26 Feb 2021Assigned to Editor
26 Feb 2021Reviewer(s) Assigned
17 Mar 2021Review(s) Completed, Editorial Evaluation Pending
17 Mar 2021Editorial Decision: Accept