2025 report on advances in thoracic aortic disease research

This review summarizes advances in thoracic aortic disease research published in 2025, with literature retrieved from 2,829 articles via PubMed searches, focusing on risk prediction, pathogenesis, and treatment strategies. In risk prediction, key advances include: biomechanical validation of ascending aortic length (AAL) as a stable morphological predictor; the relationship between clonal hematopoiesis and thoracic aortic aneurysm (TAA) linked to Janus kinase 2 (JAK2) (V617F) mutation variant allele frequency (VAF); the iAorta artificial intelligence (AI) system achieving acute aortic syndrome (AAS) detection on non-contrast computed tomography (CT); and sex differences revealed by the DisSEXion study demonstrating significantly higher type A dissection incidence in women. Additional advances include cardiac magnetic resonance (CMR)-derived three-dimensional (3D) distensibility and displacement mapping, high biaxiality ratio analysis, integration of phenotypic age acceleration with genetic risk, reduced plasma cartilage oligomeric matrix protein (COMP) levels as a warning biomarker, gene-specific differences in hereditary thoracic aortic disease (HTAD), air pollution as an environmental risk factor, and causal association between remnant cholesterol and aortic disease. In pathogenesis, the hexosamine biosynthetic pathway-integrated stress response (HBP-ISR) axis provides a common therapeutic target for both hereditary and sporadic disease; piezo type mechanosensitive ion channel component (PIEZO)1 regulates transforming growth factor (TGF)-β signaling with the Yoda1 agonist showing therapeutic potential; Calpain-2-mediated endothelial focal adhesion disruption plays a critical role in dissection; CX3CR1+ macrophages can be targeted by C-C chemokine receptor (CCR)2 antagonist, which mitigates aneurysm progression; the cyclin-dependent kinase-like (CDKL)1-ciliary function association introduces ciliary biology into aortic pathophysiology; and developmental origin-dependent susceptibility differences among smooth muscle cells (SMCs) are identified. In treatment, the frozen elephant trunk (FET) strategy shows excellent long-term survival and functional recovery. The Society of Thoracic Surgeons (STS) risk model improves preoperative assessment. Analysis clarifies high mortality risks associated with coronary and mesenteric malperfusion. PERSEVERE study confirms favorable aortic remodeling with Ascyrus Medical Dissection Stent (AMDS) hybrid prosthesis. Importantly, research emphasizes the critical role of hospital rescue capability and regionalized aortic care networks, with evidence supporting efficient inter-hospital transfer systems to improve outcomes. Advances in compliant stent-grafts and total endovascular aortic arch repair techniques expand treatment options for high-risk patients.