Acquired cardiovascular disease
Modeling of predissection aortic size in acute type A dissection: More than 90% fail to meet the guidelines for elective ascending replacement

Read at the 94th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario Canada, April 26-30, 2014.
https://doi.org/10.1016/j.jtcvs.2014.05.050Get rights and content
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Objectives

The current guidelines for ascending aortic replacement were determined from already dissected aorta diameters. Previous computed tomography-based work on humans who underwent imaging before and directly after aortic dissection onset has shown an average 30% increase in the ascending aortic diameter with acute dissection. The present investigation evaluated the incidence of predissection ascending aortic dilatation in acute type A dissection.

Methods

From 2002 to 2013, 495 patients presented with acute type A aortic dissection to 1 center. Of these cases, 343 were non-Marfan, nonbicuspid with spontaneous dissection etiology. In those with available preoperative computed tomography angiograms (n = 83) or transesophageal echocardiograms (n = 260), the predissection ascending aorta diameters were modeled from the dissected aorta diameters by subtraction of the average diameter increase rate.

Results

Altogether 343 patients were included (age, 62 years; range, 53-73; 64% men). The median modeled predissection ascending diameter was 3.7 cm (first quartile, 3.3; third quartile, −4.1). Of the 343 patients, 334 (97%) and 315 (92%) had an ascending diameter before dissection onset of <5.5 cm and <5.0 cm, respectively. More than 60% of women and 70% of men had a nondilated ascending aorta before type A dissection onset. The median predissection ascending aortic diameter did not differ between women and men (3.7 cm; first quartile, 3.4; third quartile, 4.2; vs 3.7 cm; first quartile, 3.3; third quartile, 4.1; P = .810).

Conclusions

More than 60% of patients with spontaneous, non-Marfan, nonbicuspid, type A dissection will have a nondilated ascending aorta before dissection onset. Only 3% would meet the criteria for elective ascending replacement to prevent aortic dissection. Additional research on the genetic and biochemical predictors of aortic dissection is essential.

CTSNet classification

26.1

Abbreviations and Acronyms

BSA
body surface area
CT
computed tomography
CTA
computed tomography angiogram
TEE
transesophageal echocardiogram

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Disclosures: Authors have nothing to disclose with regard to commercial support.