Dilineating the unique aortic landscape in India Dimensional variability and inflammatory aortic pathology

This thesis explores the unique pattern of aortic disease in India as compared to the Western population, emphasizing the regional difference in patient characteristics which includes the age of onset, the smaller body habitus, and more importantly the relative high prevalence of inflammatory aortopathies. This research remonstrances the universal application of absolute aortic diameter thresholds for interventions in the aorta. Our findings suggest that the future guidelines should account for population-specific disparities in aortic dimensions to optimize personalized surgical decision-making.
The initial chapters demonstrate that Indian patients possess significantly smaller absolute aortic diameters than Western cohorts. Aortic dimensions in the Indian population were compared with the Dutch population, and the Indian cohort had a smaller absolute diameter of the aorta. These chapters stress the importance of incorporating indexed measurements to accommodate better surgical decision-making in a different ethnic cohort.
The next few chapters concentrate on the unique regional challenges in aortic disease, specifically Takayasu arteritis and tuberculous aortitis. The chapter on aortoarteritis highlights the technical challenges cardiothoracic surgeons face while operating on these patients and also insists on providing optimum medical therapy along with corrective surgery. The surgery on Tuberculosis aortitis requires a unique tailored approach, apart from long term anti-tuberculosis treatment after the surgery.
The final chapters speak about the contemporary surgical practice in India through a nationwide survey on Acute Type A Aortic Dissection. The survey showed that there is a significant heterogeneity in cannulation strategies and prosthesis sizing. Collectively, this work highlights the need for individualized risk assessment, establishing high-volume aortic centres for optimize outcomes in the Indian healthcare context.