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Research project

‘SIZE MATTERS’ project: Male-female differences in thoracic aortic disease

Status: Ongoing project. Start date: 01-10-2017 End date: 30-09-2021.

Multicenter and multidisciplinary project on male-female differences in all aspects of thoracic aortic diseases. The ultimate goal of this project is to develop a patient information portal, and clinician decision aid, using the data from this project. Research topics to achieve this goal include: quality of life, aortic dissection, outcome after aortic surgery, biomarkers, genetics, and immunohistological and biomechanical properties of the thoracic aorta.

What we do

About our project


The SIZE MATTERS project aims to implement male-female specific insights of aortic root and ascending aorta characteristics into clinical practice, allowing better identification of high risk Thoracic Aortic Aneurysm (TAA) patients, better timing of intervention based on reliable cut-off values for aorta diameter, stress reduction, better quality of life, and better informed patients who are empowered to participate in clinical decisions.


For this project we started a multicenter collaboration, including the Erasmus MC Rotterdam, Radboud UMC Nijmegen, LUMC Leiden and UZ Antwerpen and Catharina Ziekenhuis Eindhoven. On top of that we also have a multidisciplinary approach. Our project includes researchers from many different disciplines: cardiothoracic surgery, cardiology, psychology, epidemiology, anatomy / pathology, genetics and radiology.

Our research focus


In order to achieve this, we study: normal and abnormal growth of the aorta in males and females; presentation, treatment and outcomes of males and females in relation to onset of acute aorta events; the prognostic value of biomarkers; the impact of X-linked genetic background; quality of life in males and females with aortic diseases; outcome after aortic surgery in males and females. The results will be used to develop a clinical decision model for the optimal timing of intervention taking into account male-female and size differences, and to make a gender-sensitive information portal with decision aid for patients.

Impact on patient care

Integrating all the research from this project into a patient information portal with a decision making tool will improve patient care. A web-based application will be developed in a multidisciplinary working group, including patient representatives, in collaboration with ZorgKeuzeLab. This will provide patients with an up-to-date reliable website to find information about their disease, help with treatment decision making and improve shared decision making and quality of life.

Funds & Grants

This project was funded by a  ZonMW ‘gender en gezondheid’ grant, project number 849200014.


Collaborations within Erasmus MC

  • Cardiology
  • Cardiothoracic surgery
  • Psychology and epidemiology and radiology.

Collaborations outside of Erasmus MC

  • Anatomy / pathology (LUMC)
  • Genetics (Radboud UMC / UZ Antwerpen)
  • Cardiology (Radboud UMC, Catharina ziekenhuis Eindhoven)
  • Psychology (Radboud UMC)
  • Cardiothoracic surgery (Radboud UMC, Catharina Ziekenhuis Eindhoven, MUMC)
  • ZorgKeuzeLab, Delft 


Exercise and sports participation in patients with thoracic aortic disease: a review. Thijssen CGE, Bons LR, Gökalp AL, Van Kimmenade RRJ, Mokhles MM, Pelliccia A, Takkenberg JJM, Roos-Hesselink JW. (2019). Expert Rev Cardiovasc Ther. 2019 Apr;17(4):251-266.

Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old. Gökalp AL, de Heer F, Etnel JRG, Kluin J, Takkenberg JJM. Ann Cardiothorac Surg. (2019). Ann Cardiothorac Surg. 2019 May;8(3):372-382.

Decision-Making in Thoracic Aortic Aneurysm Surgery-Clinician and Patient View. Gökalp AL, Takkenberg JJM. Semin Thorac Cardiovasc Surg. (2019). Semin Thorac Cardiovasc Surg. 2019 Winter;31(4):638-642.

Our team