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Disease of the Thoroco-Abdominal Aorta (TAA)
The National Heart, Lung, and Blood Institute convened a Working Group on September 19, 2005, in Bethesda, Maryland to identify clinical research opportunities and critical gaps in our knowledge about thoraco-abdominal aortic diseases in order to facilitate clinical detection and treatment of these diseases. The major objectives were to: (1) review the current state of basic research of thoraco-abdominal aortic diseases as it applies to future clinical applications; (2) identify basic science findings that are ready for translation into clinical research; (3) foster exchange of novel ideas to promote improved understanding of the temporal structural and mechanical changes that relate to disease progression of the thoraco-abdominal aorta; (4) identify research opportunities to improve clinical decision-making and health care delivery in order to optimize patient outcomes:, and (5) provide a prioritized set of novel research recommendations to the NHLBI that will direct its future research agenda and ultimately improve the diagnosis and treatment of diseases of the thoraco-abdominal aorta.
The Working Group members reviewed recent findings in basic research,
clinical diagnosis, and treatment strategies related to diseases of the
TAA. The discussion focused on the need for an improved understanding
of the natural history of TAA diseases. There are few, if any, animal
models of TAA disease. The Working Group thought that reliable animal
models should be developed that replicate the etiology and pathogenesis
of TAA diseases in humans. Members agreed that research using relevant
animal models is an important intermediate step in the translation of
results from basic science into clinical trials. In addition, the group
stated that human TAA tissue must be collected and studied to evaluate
gene and protein expression and elucidate histologic, biochemical, mechanical,
and structural properties of TAA diseases.
Important gaps in our understanding of diseases of the TAA include: the potential benefits of endovascular repair of type B aortic dissection compared to optimal medical therapy; the benefits and risks of endovascular compared with surgical repair of TAA aneurysms; and the effects of medical therapies such as beta adrenergic blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers on expansion and outcome of aneurysms of the TAA. Randomized clinical trials were considered important mechanisms to develop new therapies for diseases of the TAA.
Understanding mechanisms of neurologic injury and spinal cord protection,
in both surgical and endovascular repair, are needed to improve pharmacologic,
endovascular and surgical treatment strategies in order to prevent paraplegia
A summary of the workshop proceedings and recommendations will also be published in a peer-reviewed scientific journal. Anticipated publication date is 2006.
Suzanne Goldberg, R.N., M.S.N., NHLBI, NIH
Last updated: October 28, 2005