Knowledge, Attitudes and Practice Preferences in the Surgical Threshold for Ascending Aortic Aneurysm among Canadian Cardiac Surgeons

Abstract Objective The survey aimed to assess the practice patterns of Canadian cardiac surgeons on the size threshold at which patients with ascending aortic aneurysm would be offered surgery. Methods A 18-question electronic survey was electronically distributed to 148 practicing cardiac surgeons in Canada via email from January to August, 2020. Questions presented clinical scenarios focusing on modifying a single variable, and respondents were asked to identify their surgical size threshold for each of the clinical scenarios. Results The individual response rate was 62.0% (91/148) and institutional response rate was 89.3% (25/29). For an incidental asymptomatic ascending aortic aneurysm in a 60-year old otherwise healthy male patient with a tricuspid aortic valve and BSA of 1.9m2, 20.2% of the respondents would recommend surgery when the aneurysm was Conclusions Practice variations exist in the current size threshold for surgery of ascending aortic aneurysms in Canada. These differences between surgeons are further accentuated in the context of BAV, smaller body stature, younger age, low growth rate, family history, and for the performance of isometric exercise. These represent important areas where future prospective studies are required to inform best practice.