Indications and imaging for aortic surgery: Size and other matters

Elefteriades, John A.; Ziganshin, Bulat A.; Rizzo, John A.; Fang, Hai; Tranquilli, Maryann; Paruchuri, Vijayapraveena; Kuzmik, Gregory A.; Gubernikoff, George; Dumfarth, Julia; Charilaou, Paris; Theodoropoulos, Panagiotis

doi:10.1016/j.jtcvs.2014.07.066

Cited by 63 publications

(32 citation statements)

References 15 publications

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“…Other portions of the aorta show a considerably higher growth rate. In a recent study from our group, we evaluated the growth rates from our institutional database at the Aortic Institute at Yale-New Haven and found a growth rate of 2.0 mm per year in the ascending and arch portion, 2.26 mm per year in the descending aorta, and 2.3 mm per year in the thoracoabdominal sector (data are displayed in Fig 1) [15]. The dilation over time in these portions also increases with larger diameter.…”

Section: Growth Behavior Of Aortic Root and Other Portionsmentioning

confidence: 99%

“…Annual growth rates according to different portions of the aorta: aortic root (bright blue line); ascending aorta and arch (dark blue line); descending aorta (green line); and thoracoabdominal aorta (brown line). (Data on the ascending aorta and arch, descending aorta, and thoracoabdominal aorta were evaluated and taken from a recent publication of our group[15]). …”

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confidence: 99%

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The Aortic Root: Natural History After Root-Sparing Ascending Replacement in Nonsyndromic Aneurysmal Patients

Peterß

Bhandari

Rizzo

et al. 2017

The Annals of Thoracic Surgery

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Section: Growth Behavior Of Aortic Root and Other Portionsmentioning

confidence: 99%

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confidence: 99%

The Aortic Root: Natural History After Root-Sparing Ascending Replacement in Nonsyndromic Aneurysmal Patients

Peterß

Bhandari

Rizzo

et al. 2017

The Annals of Thoracic Surgery

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“…Interestingly, the scientifi c basis for our decision makings when indicating the time point for intervention is mainly based on historical morphological studies as we continue to rely on maximum diameters and few advances have been made beyond conventional size criteria [1]. Anyhow we know that aneurysms will rupture sooner or later, dissections will occur with a dismal natural course without treatment and the natural history of penetrating atherosclerotic ulcers is an aggressive one without a clear correlation to diameter.…”

Section: Natural Historymentioning

confidence: 99%

A pragmatic approach in aiming to do the right things in patients with thoracic aortic pathology involving the aortic arch

Czerny

2015

Cor Vasa

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V posledním desetiletí byla chirurgická komunita zaplavena celou řadou možností léčby pacientů s onemocněním hrudní aorty postihujícím aortální oblouk do té míry, že nabídka převyšuje "poptávku". Před chirurgy tak vyvstala nutnost volby mezi klasickými výkony a několika dalšími možnostmi, z nichž některé jsou vhodné, některé nevhodné a některé vysloveně špatné. Tento článek má posloužit jako praktická příručka pro lékaře zajímající se o toto téma a léčící pacienty s onemocněním hrudní aorty, která lékaře seznámí s vývojem a průběhem tohoto onemocnění, poučí ho o správném načasování léčby s odpovídající stratifi kací rizika, představí mu různé možnosti a upozorní ho na nutné kroky před zahájením samotné léčby.

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“…Over the past decades, clinical research has primarily focused on identifying its etiology and triggers. Aortic size and its biomechanical implications (Laplace law) consequent to dilation has been identified as one of the key triggers [1,2,3,4,5,6,7]; however, it still remains controversial at which aortic diameter to intervene and how aggressively the aorta should be proactively treated.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention

et al. 2018

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Background: Multiple studies have quantified the relationship between aortic size and risk of dissection. However, these studies estimated the risk of dissection without accounting for any increase in aortic size from the dissection process itself. Objectives: This study aims to compare aortic size before and after dissection and to evaluate the change in size consequent to the dissection itself. Methods: Fifty-five consecutive patients (29 type A; 26 type B) with aortic dissection and incidental imaging studies prior to dissection were identified and compared to a control group of aneurysm patients (n = 205). The average time between measurement at and prior to dissection was 1.7 ± 1.9 years (1.9 ± 2.0 years mean inter-image time in the control group). A multivariate regression model controlling for growth rate, age, and gender was created to estimate the effect of dissection itself on aortic size. Results: The mean aortic sizes at and prior to dissection were 54.2 ± 7.0 and 45.1 ± 5.7 mm for the ascending aorta, and 47.1 ± 13.8 and 39.5 ± 13.1 mm for the descending aorta, respectively. The multivariable analysis revealed a significant impact of the dissection itself (p < 0.001) and estimated an increase in size of 7.65 mm (ascending aorta) and 6.38 mm (descending aorta). Thus, a proportional estimate of 82.8% (ascending aorta) and 80.8% (descending aorta) of dissections are made at a size lower than the guideline-recommended threshold (55 mm). Conclusions: The aortic diameter increases substantially due to aortic dissection itself and, thus, aortas are being dissected at clinically meaningfully smaller sizes than natural history analyses have previously suggested. These findings have important implications regarding the size at which the risk of dissection is increased.

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Indications and imaging for aortic surgery: Size and other matters

Cited by 63 publications

References 15 publications

The Aortic Root: Natural History After Root-Sparing Ascending Replacement in Nonsyndromic Aneurysmal Patients

The Aortic Root: Natural History After Root-Sparing Ascending Replacement in Nonsyndromic Aneurysmal Patients

A pragmatic approach in aiming to do the right things in patients with thoracic aortic pathology involving the aortic arch

Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention

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