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Heart, Lung and Circulation

Can We Better Differentiate Type A Dissections: Evaluating the Role of Aortic Ratios

  • Author Footnotes
    § These authors contributed equally to this work.
    Varun J. Sharma
    Correspondence
    Corresponding author at: Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand
    Footnotes
    § These authors contributed equally to this work.
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand

    Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Vic, Australia

    Waikato Institute of Surgical Education and Research (WISER), Hamilton, New Zealand
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  • Author Footnotes
    § These authors contributed equally to this work.
    Miae Kang
    Footnotes
    § These authors contributed equally to this work.
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand

    Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Vic, Australia
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  • Jegatheesan Saravana Ganesh
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand

    Waikato Institute of Surgical Education and Research (WISER), Hamilton, New Zealand
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  • David J. McCormack
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand

    Waikato Institute of Surgical Education and Research (WISER), Hamilton, New Zealand

    Department of Surgery, University of Auckland, Hamilton, New Zealand
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  • Minesh Prakash
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand

    Waikato Institute of Surgical Education and Research (WISER), Hamilton, New Zealand
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  • Richard Moore
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand
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  • Author Footnotes
    # These authors contributed equally to this work.
    Nishith N. Patel
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand

    Waikato Institute of Surgical Education and Research (WISER), Hamilton, New Zealand

    Department of Surgery, University of Auckland, Hamilton, New Zealand
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
    Adam El-Gamel
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Cardiothoracic Surgery, Waikato District Health Board, Hamilton, New Zealand

    Waikato Institute of Surgical Education and Research (WISER), Hamilton, New Zealand

    Department of Surgery, University of Auckland, Hamilton, New Zealand
    Search for articles by this author
  • Author Footnotes
    § These authors contributed equally to this work.
    # These authors contributed equally to this work.

      Objectives

      Type A aortic dissection (ATAAD) is hypothesised as a progression of aneurysmal dilation, but 60% of patients in the International Registry of Acute Aortic Dissection (iRAD) registry had a maximum aortic diameter (MAD)<55 mm. We aim to demonstrate that size ratios and aortic wall stress, assessed using a simplified markers, are unique to aortic patients who have had adverse events (ATAAD) compared to those who have not (thoracic aortic aneurysm [TAA]).

      Methods

      A retrospective cohort analysis of patients who underwent aortic intervention at Waikato Hospital, New Zealand between 2015–2020, comparing dissection (ATAAD) to TAA patients. MAD; ratio of MAD to standardised-points within the aorta; and MAD-to-height collected from computed tomography (CT)-scans of all patients was undertaken. Receiver operating characteristic (ROC)-analysis to determine cut-off point for each marker was undertaken together with multivariable logistic regression comparing both cohorts, cross-validated by propensity-score matched analysis.

      Results

      Cohort of 215 patients, 78 (36.3%) ATAAD and 137 (63.7%) TAA; median age at intervention 63.3 years, 52 (24.2%) females, both cohorts matched for size. Using the entire cohort, the MAD: sinus of Valsalva (SoV) ratio>1.06 (cut-off value) had 4.5-times greater association with ATAAD (95%CI 1.46–13.8) and a 0.1-unit increased conferred 1.45-times greater association with ATAAD (95%CI 1.00–2.08). MAD>55 mm only seen in 33.3% of ATAAD (n=26/78), and not associated with ATAAD (OR 1.88, 95%CI 0.64–5.51). Compared to MAD, MAD:SoV ratio had greater sensitivity (33% vs 73%), lower number-needed-to-treat (17.9 vs 2.7) and superior discrimination (area under the curve [AUC] 0.54 vs 0.71). Findings were consistent with propensity score matched analysis.

      Conclusions

      MAD:SoV ratio significantly correlates with ATAAD (4.5 times), with superior sensitivity, discrimination, and attributable-risk-percentage compared to MAD alone.

      Keywords

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