Key result
Ascending thoracic aortic aneurysms grow ~1 mm/y, suggesting annual surveillance imaging is often too frequent.
Why the study?
Studies on thoracic aortic aneurysm growth rates vary widely in populations, methodology, and outcomes, with few high-quality longitudinal studies and no known predictors of aortic growth rate.
Meta-Analysis
Ascending thoracic aortic aneurysms typically grow at 0.25 to 1 mm/y across various pathogeneses, suggesting that annual surveillance may be too frequent to detect growth in most patients.
May support less frequent surveillance imaging in stable ascending TAAs; extends pooled observational estimates of slow growth.
BACKGROUND: Thoracic aortic aneurysm (TAA) is an indolent, potentially fatal disease, which progresses at variable rates that are influenced by pathogenesis and patient characteristics. We conducted a systematic review and meta-analysis to synthesize the current evidence on growth rate (GR) and predictive factors among patients with syndromic and nonsyndromic heritable thoracic aortic disease, bicuspid aortic valve, and sporadic TAA. METHODS AND RESULTS: Online databases were searched for studies that reported aortic growth on adult patients with asymptomatic TAA. Pooled GRs were calculated for 3 different TAA groups: syndromic heritable thoracic aortic disease, bicuspid aortic valve, and sporadic TAA. The search yielded 6297 studies, of which 85 were included in the systematic review, and 55 in the meta-analysis of growth rate (10 syndromic heritable thoracic aortic disease, 31 bicuspid aortic valve, and 34 sporadic subgroups). Mean observed TAA GR was 0.25 mm/y (95% CI, -0.18 to 0.68) in Turner syndrome, 0.45 mm/y (95% CI, 0.00-0.90) in Marfan syndrome, and 0.81 mm/y (95% CI, -0.46 to 2.08) in Loeys-Dietz syndrome. The mean observed GR in patients with bicuspid aortic valve before aortic valve surgery was 0.37 mm/y (95% CI, 0.29-0.46), compared with 0.18 mm/y (95% CI, 0.14-0.33) in postsurgical studies. Mean observed GR in sporadic ascending TAA was 0.33 mm/y (95% CI, 0.13-0.52) and 2.71 mm/y (95% CI, 0.53-4.88) in descending TAA. CONCLUSIONS: Considering all pathogeneses, ascending TAAs typically grow at 0.25 to 1 mm/y, and thus annual surveillance is likely too frequent to detect growth in most patients. Studies vary widely in populations, methodology, and outcomes, with few high-quality longitudinal studies and no predictors of aortic GR.
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Henry et al. (2025) conducted a meta-analysis in Thoracic aortic aneurysm. Thoracic aortic aneurysm (syndromic, bicuspid aortic valve, and sporadic) was evaluated on Aortic growth rate. Ascending thoracic aortic aneurysms typically grow at 0.25 to 1 mm/y across various pathogeneses, suggesting annual surveillance is likely too frequent to detect growth in most patients.
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