Surgery Versus Surveillance: A Quality-of-Life Analysis of Patients With Moderately Dilated Aortic Root or Ascending Aorta

OBJECTIVES: The impact of diagnosis and management of ascending thoracic aortic aneurysm (ATAA) on patients' quality of life (QoL) is not well characterized. This study aims to compare QoL with surgery versus surveillance in patients with moderate ATAAs. METHODS: Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance is a multicentre randomized trial for patients with ATAA between 5.0 and 5.4 cm and includes a registry of patients who underwent either surgery or surveillance. From May 2019 to December 2022, 157 patients from 15 centres were enrolled in the surveillance (n = 105) or surgery (n = 52) registry and completed baseline and follow-up 36-item short form survey (SF-36) for QoL assessment. The primary outcomes were changes in physical component summary and mental component summary (MCS) scores. Propensity matching was performed to adjust for baseline differences. RESULTS: Patients in the surveillance arm were older and had higher prevalence of hypertension, dyslipidaemia, and atrial fibrillation (all P < 0.05). The overall mean duration between baseline and follow-up SF-36 questionnaire was 13.2 ± 3.6 months. After propensity match, compared to scores at baseline, patients in the surgery arm experienced significantly greater improvement in scores in MCS (4.1 ± 10.9 vs 0.1 ± 7.7; P = 0.04), general health (7.2 ± 17.6 vs -0.7 ± 14.5; P = 0.02), and mental health (9.5 ± 17.5 vs 1.4 ± 13.4; P = 0.01). CONCLUSIONS: In a multicentre, prospective, non-randomized comparison of patients with moderate ATAAs, surgical treatment was associated with improvement in mental components of QoL at 1 year compared to surveillance.