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20 years of Cleveland Clinic experience in ~500 patients with proximal aortic aneurysm or dilation
Technique features heavyweight guidewire and electrocautery to access the aortic sac
Findings hold implications for screening and potential nonsurgical therapy
Cleveland Clinic experience points to a symptoms- and complications-based approach
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Perioperative disadvantages give way to better survival, fewer reinterventions by 5-10 years
A staged hybrid strategy respects the chronic nature of thoracic aortic disease
12-year-old will likely avoid some future surgeries thanks to multidisciplinary expertise
Residual dissection requires lifelong surveillance
Pathophysiologic understanding and deep experience with BAV are invaluable
Advice on combining size-based management with family history and other factors
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