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

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 aort...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2014-09, Vol.148 (3), p.944-948.e1
Main Authors: Rylski, Bartosz, MD, Branchetti, Emanuela, PhD, Bavaria, Joseph E., MD, Vallabhajosyula, Prashanth, MD, Szeto, Wilson Y., MD, Milewski, Rita K., MD, PhD, Desai, Nimesh D., MD, PhD
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Aneurysm, Dissecting - diagnosis
Aneurysm, Dissecting - epidemiology
Aneurysm, Dissecting - surgery
Aortic Aneurysm - diagnosis
Aortic Aneurysm - epidemiology
Aortic Aneurysm - surgery
Aortography - methods
Blood Vessel Prosthesis Implantation
Cardiothoracic Surgery
Echocardiography, Transesophageal
Elective Surgical Procedures
Female
Germany - epidemiology
Guideline Adherence
Humans
Incidence
Male
Middle Aged
Patient Selection
Practice Guidelines as Topic
Predictive Value of Tests
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
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Summary: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
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2014.05.050