Aortic elongation in aortic aneurysm and dissection: the Tübingen Aortic Pathoanatomy (TAIPAN) project†

Krüger, Tobias; Boburg, Rodrigo Sandoval; Lescan, Mario; Oikonomou, Alexandre; Schneider, W; Vöhringer, Luise; Lausberg, Henning; Bamberg, Fabian; Blumenstock, Gunnar; Schlensak, Christian

doi:10.1093/ejcts/ezx503

Cited by 43 publications

(30 citation statements)

References 18 publications

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“…Without mentioning the difference between bicuspid and tricuspid aortic valves, Krüger and colleagues published several articles linking the incidence of aortic dissection with the length of the ascending aorta (Krüger et al, ), allowing them to establish a dissection risk score in the TAIPAN project (Krüger et al, ). Without assessing the risk of dissection, we identified differences in the ascending aortic lengths between our two groups.…”

Section: Discussionmentioning

confidence: 99%

Bicuspid and tricuspid aortic valve do not have the same ascending aorta morphology

et al. 2018

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Bicuspid aortic valves are associated with histopathological abnormalities of the aorta. Their diameters have been measured in several studies, but the literature concerning changes in the overall anatomy of the ascending aorta is limited. We wanted to know whether the anatomy of the valve, bicuspid or tricuspid, is associated with anatomical differences. We prospectively included patients requiring aortic valve surgery. The protocol included a chest CT scan before the operation to determine the angulations and straight lengths of aortic segments 0 and 1. All of the patients underwent surgery to assess their aortic valve morphology. We included 107 patients, 25 (23%) with bicuspid diagnostic valves and 82 (77%) with tricuspid ones. Most angulations were similar between the groups. However, the angle between the ring and the plane of the top of the commissures of the semilunar cusps was lower in bicuspid than tricuspid aortic valves. The straight lengths in the aortic root did not differ significantly, but the lengths separating these planes from the BCAT plane were consistently greater in the bicuspid group. The angle between the ring plane and the patient's vertical axis was lower in the bicuspid, the plane of the ring being verticalized in this group. In conclusion, we were able to confirm significant morphological differences in addition to the diameters. However, this study does not establish causal relationships among valve morphology, ascending aortic morphology, histology, and possibly associated pathologies. An extremely large cohort will be required indicate such causal connections. Clin. Anat. 31:693-697, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Bicuspid and tricuspid aortic valve do not have the same ascending aorta morphology

et al. 2018

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“…However, the observation that the entrance of the aortic dissection mostly extends in a circumferential direction could be explained by decreased longitudinal elasticity due to aortic elongation (53,88). Meanwhile, a previous study also showed that the length of the AAEs aorta processed from 3D reconstruction based on CTA is significantly larger than the non-AAEs aorta (7,78). These findings led to further investigation into the correlation, if any, between aortic length and the risk of AAEs (Figure 1) (7,78).…”

Section: Aortic Lengthmentioning

confidence: 96%

“…Thus, as the centerline method increasingly used, it may be necessary to ''left-shift'' the thresholds (30). Furthermore, there is also a method of calculating the diameter based on the circumference to minimize the influence of the non-circular aorta (7,31). The above evidence suggests that a unified acquisition protocol and general morphological parameters should be developed to eliminate heterogeneity caused by different measurement methods (22).…”

Section: Absolute Aortic Diameter As An Indicatormentioning

confidence: 99%

New indicators for systematic assessment of aortic morphology: a narrative review

Luan¹,

Mao²,

Zhu³

et al. 2021

J Thorac Dis

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In order to prevent the occurrence of aortic adverse events in ascending thoracic aortic aneurysm patients, preventive surgery is the sole option in case of large aneurysm. Identifying high-risk patients timely and accurately requires effective predictive indicators of aortic adverse events and accurate risk stratification thresholds. Absolute diameter measured after a single imaging examination, which has been used as the predictive indicator for decades, has been proved to be ineffective for risk stratification in moderately dilated aorta. Previously, new indicators combining absolute diameters with personalized parameters have been reported to show better predictive power of aortic adverse events than absolute diameters by correcting the effect of these parameters on the diameters. Meanwhile, combining three-dimensional parameters to formulate risk stratification thresholds not only may characterize the aortic risk morphology more precisely, but also predict aortic adverse events more accurately. These new indicators may provide more systematic assessment methods of patients' risk, formulate more personalized intervention strategies for ascending thoracic aortic aneurysm patients, and also provide a basis for researchers to develop more accurate and effective risk thresholds. We also highlight that the algorithm obtained by combining multiple indicators may be a better choice compared with single indicator, but this still requires the support of more evidence.Due to the particularity of syndromic aortic disease, whether these new indicators can be used for its risk stratification is still uncertain. Therefore, the scope of this manuscript does not include this kind of disease.

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“…Recent publications have focused on identifying new morphological predictors or morphological risk factors with the purpose to improve screening and prevention of AAAD since the simple reduction of the maximum aortic diameter cut-off value would not necessarily imply a net benefit in terms of mortality (2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

3D morphometric analysis of ascending aorta as an adjunctive tool to predict type A acute aortic dissection

Saade¹,

Vinciguerra²,

Romiti³

et al. 2021

J Thorac Dis

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Background: Acute type A aortic dissection (AAAD) is a pathological process that implicates the ascending aorta and represents a surgical emergency burdened by high mortality if not promptly treated in the first hours of onset. Despite best efforts, the annual incidence rates of aortic dissection has remained stable over the past decades. We measured aortic dimensions (aortic diameters, area, length and volume) using 3D multiplanar reconstruction imaging with the purpose of refining the risk-morphology for AAAD. Methods: Computerized tomography angiography studies of three groups were compared retrospectively: patients affected by AAAD (AAAD group; n=71), patients affected by aortic aneurysm and subsequently subjected to ascending aorta replacement (Aneurysm, n=77) and a healthy aorta's group (Control, n=75). Results: Mean diameters of AAAD (4.9 cm) and Aneurysm (5.1 cm) aortas were significantly larger than those of the control group (3.4 cm). In AAAD patients, an ascending aorta diameter greater than 5.5 cm was observed in 18% of patients. Multiple comparisons showed statistically significant differences among mean of the ratio of aortic root area to height between the three groups (P<0.001). In frontal and sagittal planes, the length of the ascending aorta was significantly greater in patients affected by aortic pathology (AAAD and aneurysm) than in the control group (P<0.001). Significant differences were confirmed when indexing the aortic length to patient's height and BSA, and the aortic volume to patient's BSA. Conclusions: Maximum transverse diameter, considered separately, is not the best predictor of aortic dissection. In our opinion, the introduction into clinical practice of measurements of the area, length, and volume of the aorta, as absolute or indexed values, could improve the selection of patients who would benefit from preventive surgical aortic replacement.

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Aortic elongation in aortic aneurysm and dissection: the Tübingen Aortic Pathoanatomy (TAIPAN) project†

Abstract: Patients with ectatic (45-54 mm diameter) and elongated (≥120 mm) ascending aortas represent a high-risk subpopulation for TAD.

Cited by 43 publications

References 18 publications

Bicuspid and tricuspid aortic valve do not have the same ascending aorta morphology

Bicuspid and tricuspid aortic valve do not have the same ascending aorta morphology

New indicators for systematic assessment of aortic morphology: a narrative review

3D morphometric analysis of ascending aorta as an adjunctive tool to predict type A acute aortic dissection

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