Year: 2025
Type: letter
Abstract: We appreciate Professor Treasure's 1 interest in our study and his thoughtful comments on survivorship bias.We agree that type A aortic dissection remains the greatest risk for this population and that prevention is a major focus of aortic surgeons.We are not advocating against prophylactic root replacement, but for more frequent monitoring and stringent medical management given their higher distal dissection incidence.The alarming discrepancy in type B dissection was a surprise finding in our previous study by Dhanekula and colleagues. 2 Our current study compared this rate in patients with Marfan syndrome (MFS) after root replacement to those without root surgery.The comparator group without root replacement was propensity matched to surgical counterparts using factors including family history and genetic mutational class.3 Genetic mutational class remains an area of research but may better predict aggressive aortopathy requiring earlier intervention.Thus, although we acknowledge Professor Treasure's consideration of survivor bias, we do not think the evidence in our data suggests it played a significant role in driving the notable discrepancy in type B dissection.Of course, undiagnosed individuals with MFS (and thus not captured by our database) may be suffering aortic mortality that could drive a survivor bias.Therefore, we cannot
Authors: Ryan Thomas, Arjune Dhanekula, Christopher Burke
Institution: University of Washington
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,500
OpenAlex ID: W4415448031