Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery?

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License: CC BY-NC 4.0
Serval ID
serval:BIB_0A8B2D8CC94F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery?
Journal
European journal of cardio-thoracic surgery
Author(s)
Tozzi P., Gunga Z., Niclauss L., Delay D., Roumy A., Pfister R., Colombier S., Patella F., Qanadli S.D., Kirsch M.
ISSN
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
29/01/2021
Peer-reviewed
Oui
Volume
59
Number
2
Pages
473-478
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Current guidelines recommend prophylactic replacement of the ascending aorta at an aneurysmal diameter of >55 mm to prevent acute Type A aortic dissection (TAAD) in non-Marfan patients. Several publications have challenged this threshold, suggesting that surgery should be performed in smaller aneurysms to prevent this devastating disease. We reviewed our experience with measuring aortic size at the time of TAAD to validate the existing recommendation for prophylactic ascending aorta replacement.
All patients who had been admitted for TAAD to our emergency department from 2014 to 2019 and underwent ascending aorta replacement were included. Marfan patients were excluded. The maximum diameter of the dissected aorta was measured preoperatively using CT scan. We estimated the aortic diameter at the time of dissection to be 7 mm smaller than the measured maximum diameter of the dissected aorta (modelled pre-dissection diameter).
Overall, 102 patients were included. Of these, 67 were male (65.6%) and 35 were female (34.4%), and the cohort's mean age was 65 ± 12.1 years. In addition, 66% were treated for arterial hypertension. The mean maximum modelled pre-dissection diameter was 39.6 ± 4.8 mm: 39.1 ± 5.1 mm in men and 40.7 ± 2.8 mm in women (P = 0.1). The cumulative 30-day mortality rate was 19.6% (20/102).
TAAD occurred at a modelled aortic diameter below 45 mm in 87.7% of our patients. Therefore, the current aortic diameter threshold of 55 mm excludes ∼99% of patients with TAAD from prophylactic replacement of the ascending aorta. The maximum diameter of the ascending aorta warrants reappraisal and this parameter should be a distinct part of a personalized decision-making process that also takes into account age, gender and body surface area to establish the surgical indication for preventive aorta replacement aimed to improve the survival benefit of this procedure.
Keywords
Acute aortic syndrome, Aortic aneurysm, Aortic dissection, Aortic surgery
Pubmed
Web of science
Open Access
Yes
Create date
09/10/2020 14:33
Last modification date
01/05/2021 6:32
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