Study on the surgical indication for patients with simple ascending aortic dilatation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Wenjian , LIU Yang , YU Changyao ,  ZHANG Hongjia

Department of Cardiac Surgery, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China;

Corresponding author：

ZHANG Hongjia, Email: zhanghongjia722@ccmu.edu.cn

Keywords：

Simple ascending aortic dilation; simple ascending aortic dissection; inner diameter of ascending aorta; surgical indication

DOI：

10.7507/1007-4848.201903005

Video：

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Objective To compare the ascending aortic diameter and postoperative outcomes of patients with simple ascending aortic dissection or simple ascending aortic dilatation and to study the reliability of the surgical indication in present guideline for Chinese patients with ascending aortic dilatation.Methods The clinical data of patients with aortic aneurysm and aortic dissection who underwent surgery at Beijing Anzhen Hospital, Capital Medical University from 2010 to 2017 were retrospectively reviewed. After exclusion of patients with Marfan syndrome, heart valve and other diseases, 139 patients were divided into two groups: a simple ascending aorta dilatation group (56 patients) and a simple ascending aortic dissection group (83 patients). The ascending aortic diameter and postoperative outcomes of two groups were compared. Results The inner ascending aortic diameter (57.30±9.41 mm vs. 50.72±9.53 mm, P <0.001) and the inner ascending aortic diameter index (31.12±5.38 vs. 27.22±6.40, P<0.001) in the simple ascending aorta dilatation group were significantly greater than those in the simple ascending aortic dissection group. For male patients, the results were similar (60.28±10.80 mm vs. 47.40±6.53 mm; 30.00±6.33 vs. 23.60±3.72, both P<0.001). But for the female patients, there was no significant difference between the two groups (54.90±7.47 mm vs. 53.81±10.84 mm; 32.03±4.37 vs. 30.58±6.56, both P>0.05). The mortality, the incidence of tracheotomy and postoperative reopen rate in the simple ascending aortic dissection group were higher.Conclusion In this study, the inner diameter of the ascending aorta in the group of ascending aorta is mostly < 5.5 cm. In our opinion, the present surgical indication for Chinese patients with ascending aortic dilatation is not enough. In the future clinical studies, we also need to find more reasonable surgical indications.

Citation： JIANG Wenjian, LIU Yang, YU Changyao, ZHANG Hongjia. Study on the surgical indication for patients with simple ascending aortic dilatation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(11): 1113-1118. doi: 10.7507/1007-4848.201903005 Copy

1.	Olsson C, Thelin S, Ståhle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14, 000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
2.	Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278.
3.	Szilagyi DE, Smith RF, DeRusso FJ, et al. Contribution of abdominal aortic aneurysmectomy to prolongation of life. Ann Surg, 1966, 164(4): 678-699.
4.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
5.	Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg, 1997, 113(3): 476-491.
6.	Coady MA, Rizzo JA, Elefteriades JA. Developing surgical intervention criteria for thoracic aortic aneurysms. Cardiol Clin, 1999, 17(4): 827-839.
7.	Ergin MA, Spielvogel D, Apaydin A, et al. Surgical treatment of the dilated ascending aorta: when and how? Ann Thorac Surg, 1999, 67(6): 1834-1839.
8.	Gott VL, Greene PS, Alejo DE, et al. Replacement of the aortic root in patients with Marfan's syndrome. N Engl J Med, 1999, 340(17): 1307-1313.
9.	Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg, 2004, 128(5): 677-683.
10.	Pape LA, Tsai TT, Isselbacher EM, et al. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation, 2007, 116(10): 1120-1127.
11.	Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg, 2006, 81(1): 169-177.
12.	Jue J, Boodhwani M, Beauchesne L, et al. Sex differences in the associations of arterial stiffness and pulsatile hemodynamics with thoracic aortic aneurysm size. Can J Cardiol, 2018, 34(4): e6.
13.	Cheung K, Boodhwani M, Chan KL, et al. Thoracic aortic aneurysm growth: role of sex and aneurysm etiology. J Am Heart Assoc, 2017, 6(2): pii: e003792.
14.	Kälsch H, Lehmann N, Möhlenkamp S, et al. Body-surface adjusted aortic reference diameters for improved identification of patients with thoracic aortic aneurysms: results from the population-based Heinz Nixdorf Recall study. Int J Cardiol, 2013, 163(1): 72-78.
15.	Paruchuri V, Salhab KF, Kuzmik G, et al. Aortic size distribution in the general population: explaining the size paradox in aortic dissection. Cardiology, 2015, 131(4): 265-272.
16.	Elefteriades JA, Ziganshin BA. Gratitude to the international registry of acute aortic dissection from the aortic community. J Am Coll Cardiol, 2015, 66(4): 359-362.

1. Olsson C, Thelin S, Ståhle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14, 000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
2. Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278.
3. Szilagyi DE, Smith RF, DeRusso FJ, et al. Contribution of abdominal aortic aneurysmectomy to prolongation of life. Ann Surg, 1966, 164(4): 678-699.
4. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
5. Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg, 1997, 113(3): 476-491.
6. Coady MA, Rizzo JA, Elefteriades JA. Developing surgical intervention criteria for thoracic aortic aneurysms. Cardiol Clin, 1999, 17(4): 827-839.
7. Ergin MA, Spielvogel D, Apaydin A, et al. Surgical treatment of the dilated ascending aorta: when and how? Ann Thorac Surg, 1999, 67(6): 1834-1839.
8. Gott VL, Greene PS, Alejo DE, et al. Replacement of the aortic root in patients with Marfan's syndrome. N Engl J Med, 1999, 340(17): 1307-1313.
9. Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg, 2004, 128(5): 677-683.
10. Pape LA, Tsai TT, Isselbacher EM, et al. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation, 2007, 116(10): 1120-1127.
11. Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg, 2006, 81(1): 169-177.
12. Jue J, Boodhwani M, Beauchesne L, et al. Sex differences in the associations of arterial stiffness and pulsatile hemodynamics with thoracic aortic aneurysm size. Can J Cardiol, 2018, 34(4): e6.
13. Cheung K, Boodhwani M, Chan KL, et al. Thoracic aortic aneurysm growth: role of sex and aneurysm etiology. J Am Heart Assoc, 2017, 6(2): pii: e003792.
14. Kälsch H, Lehmann N, Möhlenkamp S, et al. Body-surface adjusted aortic reference diameters for improved identification of patients with thoracic aortic aneurysms: results from the population-based Heinz Nixdorf Recall study. Int J Cardiol, 2013, 163(1): 72-78.
15. Paruchuri V, Salhab KF, Kuzmik G, et al. Aortic size distribution in the general population: explaining the size paradox in aortic dissection. Cardiology, 2015, 131(4): 265-272.
16. Elefteriades JA, Ziganshin BA. Gratitude to the international registry of acute aortic dissection from the aortic community. J Am Coll Cardiol, 2015, 66(4): 359-362.

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