Risk of aortic dissection in patients with ascending aorta aneurysm: a new biological, morphological, and biomechanical network behind the aortic diameter

Abstract

Thoracic aortic aneurysm represents a deadly condition, particularly when it evolves into rupture and dissection. Proper surgical timing is the key to positively influencing the survival of patients with this pathology. According to the most recent guidelines, ascending aorta size ≥ 55 mm and a rate of growth ≥ 0.5 cm per year are the most important factors for surgical indication. Nevertheless, a lot of evidence show that aortic ruptures and dissections might occur also in small size ascending aorta. In this review, we sought to analyze a new biological and morphological network behind the aortic diameter that need to be considered in order to identify the portion of patients with thoracic aortic aneurysm who are at increased risk of aortic complications, despite current aortic guidelines not advising surgical intervention in this group

The Endothelial Transcription Factor ERG Mediates a Differential Role in the Aneurysmatic Ascending Aorta with Bicuspid or Tricuspid Aorta Valve: A Preliminary Study

“…Surgical indication were: (1) aortic diameter ≥ 45 mm in presence of a severe TAV or BAV aortic valve dysfunction; (2) aortic diameter ≥ 50 mm in BAV patients without aortic valve dysfunction; (3) aortic diameter ≥ 55 in TAV patients without aortic valve dysfunction; (4) intraoperative findings unless the diameter: significant coronary ostia dislocation, aortic wall thickness, left ventricle/aortic valve disjunction with evidence of cardiac muscle in transparency at the level of the right/non coronary sinus, asymmetric dilatation of Valsalva sinus/sinuses [51]. In the grouping of patients, we have chosen a cut-off diameter of 45 mm because it is the diameter advocated in the "2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease" for ascending aorta replacement in patients with aortic valve diseases (severe stenosis or regurgitation).…”