Tara Mastracci (Barts Health NHS Trust, London, UK) advocated a comprehensive, three-armed approach to the future of personalised aortic dissection management at the 2025 Interdisciplinary Aortic Dissection Symposium (IADS; 11 September; London, UK).
Opening her talk, Mastracci defined personalised care at a specialist level as “empowering patients with the specific tools that will help them treat their disease alongside their clinical team”.
The presenter shared that the aortic team at Barts has adopted a threepronged personalised care strategy, focused on genotype, phenotype, and a factor she dubbed ‘digitype’. She told the IADS audience: “Many vascular surgeons focus on genotype and phenotype, and these things are really important, but there’s a third arm that revolves around the patient’s behaviour and interaction with the clinical team, which more and more requires digital tools.”
Starting with genotype, the presenter homed in on the need to look for genetic variants in aortic patients to inform personalised management. “Genetic testing is really important,” she said, highlighting it as a key part of the aortic dissection pathway at Barts. Looking ahead, Mastracci focused on improving the speed at which results from such testing become available. “Wouldn’t you love to have these diagnostics faster?” she asked. “Wouldn’t it be great to have mutationguided therapy for biologics or gene therapy for dissection?” Mastracci urged the audience to “stay involved in this conversation” as the field progresses.
Regarding phenotype, Mastracci’s focus was on high-risk anatomy and risk factors for aortic dissection. The presenter explained that, at Barts, every aortic dissection patient gets an echocardiogram to look at the bicuspid aortic valve, after which the team uses the Society of Thoracic Surgeons (STS) classification to discuss the true anatomy of the dissection. Mastracci shared her prediction that future care with regard to phenotype will involve changing the surveillance cadence depending on high-risk factors and focusing more on volume instead of diameter, citing the increasing availability of artificial intelligence (AI) tools to assess imaging.
Finally, Mastracci considered the ‘digitype’ aspect of personalised care for aortic dissection, focusing on the patient’s interaction with the disease and with the team through the example of blood pressure control.
Mastracci noted that blood pressure control post-discharge is “really important,” linking it to fewer acute aortic events in the short term. At Barts, Mastracci and team have built a remote post-dissection blood pressure protocol that involves patients providing blood pressure readings via an app on their smartphone. Readings are fed back to the Barts team from the community on a regular basis.
“We have 213 people in this virtual ward so far,” Mastracci reported, specifying “moderate compliance” with the app among a heavily deprived patient population.
Looking ahead, Mastracci said there is a need to start “gamifying” follow-up for patients. She explained: “I think that this is going to be a lot more fun for patients if we make it a game.” The presenter also underscored the importance of addressing the social determinants of health digital exclusion, especially among patients from lower socioeconomic backgrounds.
“At the end of the day, I think personalised care for dissection is what we’re all already doing,” Mastracci said, closing her presentation. “But surgery can’t be the only intervention we test as surgeons. We’re bigger than that. We have to make sure we take care of the whole patient.”
