The aim of this study was to compare mean maximum ascending aortic diameter at the time of acute aortic dissection with the current surgical threshold for elective ascending aortic operations on non-syndromic thoracic aortic aneurysms.
Material and Methods
All consecutive non-syndromic adult patients admitted for acute type A aortic dissection in a single tertiary centre were prospectively enrolled from April 2020 to March 2021. The primary endpoint was the difference between mean maximum aortic diameter at the time of dissection and the 5.5 cm threshold for elective repair. Secondary endpoints included 30-day/in-hospital mortality, aortic length and comparison with normal controls, length/height ratio index, “actual” preoperative Euroscore II and “predicted” Euroscore II if electively operated.
Among 31 patients ageing 67.3±12.03 years on average, mean maximum aortic diameter at the time of dissection was 5.13±0.66 cm, significantly lower than the guidelines-derived surgical threshold of 5.5 cm (p=0.004). Mean aortic length was 11±1.47 cm, also significantly longer compared normal controls reported in the literature (p<0.001). The 30-day/in-hospital mortality was 35.5%. Mean length/height ratio index was 6.18±0.76 cm/m. Finally, mean “actual” preoperative Euroscore II was 10.43±4.07 which was significantly higher than the 1.47±0.57 “predicted” Euroscore II (p<0.05).
The maximum aortic diameter at the time of acute type A aortic dissection of non-syndromic cases was significantly lower than the current recommendation for elective repair. Lowering of the current diameter-based surgical threshold of 5.5 cm may be profitable in terms of prevention, but further investigations should be undertaken. Length-based thresholds could also add to timely aortic dissection prevention.
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Published online: December 04, 2022
Accepted: October 28, 2022
Received in revised form: August 1, 2022
Received: April 22, 2022
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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- Aortic-Size Paradox: Reducing the Threshold for Intervention Will Help to Save Some Lives But We Still Need Noah to Predict the FloodHeart, Lung and CirculationVol. 32Issue 3
- PreviewIn this issue of Heart, Lung and Circulation, Papakonstantinou et al.  propose a new guideline recommendation to lower the threshold for elective surgical intervention for non-syndromic, non-familial ascending aortic aneurysms (AsAA) to 5.0 cm. There is no doubt that their single-centre analysis aligns with the data from the International Registry of Aortic Dissection (IRAD)—that only about 60% of cases with acute type A aortic dissection had maximal aortic diameters >5.5 cm at presentation, a verdict which others have previously verified [2,3].