scholarly journals Development of a multivariable prediction model for patient-adjusted aortic risk morphology

2020 ◽  
Vol 58 (4) ◽  
pp. 692-699
Author(s):  
Tobias Krüger ◽  
Rodrigo Sandoval Boburg ◽  
Hasan Hamdoun ◽  
Alexandre Oikonomou ◽  
Malte N Bongers ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Dissection ◽  
Prediction Model ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Control Group ◽  
Type A Aortic Dissection ◽  
Brachiocephalic Trunk

Abstract OBJECTIVES Preventing type A aortic dissection requires reliable prediction. We developed and validated a multivariable prediction model based on anthropometry to define patient-adjusted thresholds for aortic diameter and length. METHODS We analysed computed tomography angiographies and clinical data from 510 control patients, 143 subjects for model validation, 125 individuals with ascending aorta ectasia (45–54 mm), 58 patients with aneurysm (≥55 mm), 206 patients with type A aortic dissection and 19 patients who had received a computed tomography angiography ≤2 years before they suffered from a type A aortic dissection. Computed tomography angiographies were analysed using curved planar reformations. RESULTS In the control group, the mean ascending aortic diameter was 33.8 mm [standard deviation (SD) ±5.2 mm], and the length, measured from the aortic valve to the brachiocephalic trunk, was 91.9 mm (SD ±12.2 mm); both diameter and length were correlated with anthropometric parameters and were smaller than the respective values in all pathological groups (P < 0.001). Multivariable linear regression analysis of the control group revealed that age, sex and body surface area were predictors of ascending aorta diameter (R2 = 0.40) and length (R2 = 0.26). Bicuspidity of the aortic valve was not included in the model; its prevalence was only 3.2% in the control group but >25% in the ectasia and aneurysm groups. CONCLUSIONS The regression model provides a patient-adjusted prediction of the thresholds for aortic diameter and length. In our retrospective data, the model resulted in better identification of aortas at the risk of dissection than the conventional 55-mm diameter threshold. The model is available as an Internet calculator (www.aorticcalculator.com).

scholarly journals 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?

2020 ◽  
Author(s):  
Piergiorgio Tozzi ◽  
Ziyad Gunga ◽  
Lars Niclauss ◽  
Dominique Delay ◽  
Aurelian Roumy ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Survival Benefit ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Maximum Diameter ◽  
Type A Aortic Dissection ◽  
Aorta Replacement ◽  
Current Guidelines ◽  
Ascending Aorta Replacement

Abstract OBJECTIVES 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. METHODS 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). RESULTS 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). CONCLUSIONS 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.

scholarly journals Giant Aortic Pseudoaneurysm with Stanford Type A Aortic Dissection after Aortic Valve Replacement

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mertay Boran ◽  
Ali İhsan Parlar ◽  
Ertay Boran
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Type A Aortic Dissection ◽  
Aortic Pseudoaneurysm

Giant pseudoaneurysm of the ascending aorta is a rare but dreadful complication occurring several months or years after aortic surgery. Thoracic aortic aneurysms tend to be asymptomatic and were previously often diagnosed only after a complication such as dissection or rupture. We present a rare case of giant ascending aneurysm with Stanford type A aortic dissection occurring 6 years after aortic valve replacement and also illustrate the potential dimensions the ascending aorta may reach by a pseudoaneurysm and dissection after AVR.

scholarly journals Type A aortic dissection: Why there is still a role for echocardiography when every second counts

2020 ◽  
Vol 8 ◽  
pp. 2050313X2097308
Author(s):  
Peter Luke ◽  
Karen Booth ◽  
Ali Kindawi ◽  
Christopher Eggett
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Sensitivity And Specificity ◽  
Transthoracic Echocardiography ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Iliac Arteries ◽  
Type A Aortic Dissection ◽  
Optimal Imaging

Aortic dissection is often regarded as a catastrophic aortic syndrome with high rates of mortality. The sensitivity and specificity of transthoracic echocardiography when diagnosing acute type A aortic dissection has been reported as high as 97% and 100%, respectively, in patients with optimal imaging quality when compared to computed tomography. In this article, we discuss the benefit of transthoracic echocardiography in a patient with type A aortic dissection extending from ascending aorta to iliac arteries.

scholarly journals Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency

2016 ◽  
Vol 20 (2) ◽  
pp. 35 ◽  
Author(s):  
M. L. Gordeev ◽  
V. E. Uspenskiy ◽  
G. I. Kim ◽  
A. N. Ibragimov ◽  
T. S. Shcherbinin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Type A ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

<p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br /><strong>Methods:</strong> From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.<br /><strong>Results:</strong> The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.<br /><strong>Conclusions:</strong> Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.</p><div class="well well-small"><strong>Funding</strong></div><p><strong></strong> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies.<br /><strong></strong></p><p><strong>Conflict of interest</strong></p><p><strong></strong>The authors declare no conflict of interest.</p><p><strong>Acknowledgement</strong></p><p>The authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology &amp; Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.</p>

The role of the angle of the ascending aortic curvature on the development of type A aortic dissection: ascending aortic angulation and dissection

2019 ◽  
Vol 29 (4) ◽  
pp. 615-620 ◽  
Author(s):  
Safa Gode ◽  
Okan Akinci ◽  
Cigdem Tel Ustunısık ◽  
Onur Sen ◽  
Ersin Kadirogulları ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Additional Risk Factor ◽  
Additional Risk ◽  
Type A Aortic Dissection

Abstract OBJECTIVES Type A aortic dissection (TAD), which consists of an intimal tear in the aorta, necessitates emergency surgery. Various risk factors related to aortic dissection have been defined in the literature. According to our hypothesis, a narrower angle of ascending aortic curvature (AAAC) may be an additional risk factor in relation to aortic dissection due to the increased force applied to the aortic wall. METHODS Patients undergoing ascending aortic surgery due to an ascending aortic aneurysm (AsAA) (n = 105) and patients undergoing such surgery because of the occurrence of TAD (n = 101) were enrolled in this study. The AAAC was measured using Cobb’s method; the measurements were made on all patients by just 1 cardiovascular radiologist using 3-dimensional computerized tomographic imaging. This measurement was made indirectly by using the aortic valve and brachiocephalic artery to avoid obtaining misleading data as a result of distortions due to dissection. A statistical comparison was also performed relating the traditional risk factors for TAD to other clinical and echocardiographic parameters: the diameter of the ascending aorta and the AAAC. RESULTS The AAAC was found to be narrower statistically in the TAD group (α = 76.2° ± 17.5°) than it was in the AsAA group (α = 92.9° ± 13°) (P < 0.001). Furthermore, mean ascending aortic diameter (P = 0.019), the presence of a bicuspid aorta (P = 0.007) and aortic valve stenosis (P = 0.005) were higher in the AsAA group. According to multivariable analyses, a narrower AAAC is a significant predictor for the development of TAD (odds ratio 0.93, 95% confidence interval 0.91–0.95; P < 0.001). Overall hospital mortality from various causes including stroke, myocardial infarction, bleeding or renal failure was 13% in the TAD group and 7% in the AsAA group. CONCLUSIONS According to this study, the AAAC was significantly smaller in aortic dissection patients than in aortic aneurysm patients. This may be related to higher shear stress and elevated pressure on the ascending aorta in patients with a narrower AAAC. Thus, a narrower AAAC may be an additional risk factor in the development of TAD. Therefore, we may need to be more careful in terms of looking for the development of aortic dissection in patients with narrower AAAC.

scholarly journals Ascending Aortic Length and Its Association With Type A Aortic Dissection

2021 ◽  
Author(s):  
Daniella Eliathamby ◽  
Mariana Gutierrez ◽  
Aileen Liu ◽  
Maral Ouzounian ◽  
Thomas L. Forbes ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Control Group ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Dissection ◽  
Thoracic Aneurysms

Background The aim of this study was to determine the role of ascending aortic length and diameter in type A aortic dissection. Methods and Results Computed tomography scans from patients with acute type A dissections (n=51), patients with proximal thoracic aortic aneurysms (n=121), and controls with normal aortas (n=200) were analyzed from aortic annulus to the innominate artery using multiplanar reconstruction. In the control group, ascending aortic length correlated with diameter ( r 2 =0.35, P <0.001), age ( r 2 =0.17, P <0.001), and sex ( P <0.001). As a result of immediate changes in aortic morphology at the time of acute dissection, predissection lengths and diameters were estimated based on models from published literature. Ascending aortic length was longer in patients immediately following acute dissection (median, 109.7 mm; interquartile range [IQR], 101.0–115.1 mm), patients in the estimated predissection group (median, 104.2 mm; IQR, 96.0–109.3 mm), and patients in the aneurysm group (median, 107.0 mm; IQR, 99.6–118.7 mm) in comparison to controls (median, 83.2 mm; IQR, 74.5–90.7 mm) ( P <0.001 all comparisons). The diameter of the ascending aorta was largest in the aneurysm group (median, 52.0 mm; IQR, 45.9–58.0 mm), followed by the dissection group (median, 50.3 mm; IQR, 46.6–57.5 mm), and not significantly different between controls and the estimated predissection group (median, 33.4 mm [IQR, 30.7–36.7 mm] versus 35.2 mm [IQR, 32.6–40.3 mm], P =0.09). After adjustment for diameter, age, and sex, the estimated predissection aortic lengths were 16 mm longer than those in the controls and 12 mm longer than in patients with nondissected thoracic aneurysms. Conclusions The length of the ascending aorta, after adjustment for age, sex, and aortic diameter, may be useful in discriminating patients with type A dissection from normal controls and patients with nondissected thoracic aneurysms.

scholarly journals Unusual, Radical Treatment of Type A Aortic Dissection: A Case Report

Aorta ◽  
2020 ◽  
Vol 08 (04) ◽  
pp. 111-115
Author(s):  
Rossella M. Benvenga ◽  
Michele Bellino ◽  
Generoso Mastrogiovanni ◽  
Donato Triggiani ◽  
Rodolfo Citro ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
High Morbidity ◽  
Type A Aortic Dissection ◽  
Native Aortic Valve ◽  
Hybrid Prosthesis

AbstractType A aortic dissection, according to Stanford classification, is a surgical emergency with high morbidity and carries 56% of in-hospital mortality when surgical intervention is not performed. The surgical mortality at 30 days is 10 to 20%. The therapeutic goals are to replace the diseased ascending aorta and to treat or to monitor the distal aortic patent false lumen. When the dissection involves the aortic root and the architecture of aortic valve is normal, the surgical techniques used could be multiple: reinforce the aortic root and spare the native aortic valve or replace the aortic valve and the aortic root. The Florida sleeve technique has been developed to treat the aortic aneurysm, sparing the aortic valve in patients with connective tissue disease. Some case reports have described the use of this technique to treat an acute aortic dissection. In the following case, we present a single stage repair of the ascending aorta, aortic arch, and proximal intrathoracic aorta in a patient with Type A aortic dissection through the contemporaneous use of two techniques: Florida sleeve and Vascutek “Thoraflex” hybrid prosthesis. The use of these two techniques allows the repair/replacement of the proximal intrathoracic aorta, the sparing of the native aortic valve, the employment of a hybrid prosthesis to replace the supraortic vessels, and the creation of a descending aortic landing zone for later, distal intervention.

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