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Ascending aortic aneurysm and dissection risk: focus on aortic height index
Susanna Grego1, Alberto Pozzoli2, Tiziano Torre2
1Rare Cardiovascular Disease Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland.
Summary
The aortic diameter to height index (AHI) identifies moderate risk in acute aortic dissection patients. Patients with AHI over 2.9 cm/m require specialized assessment, regardless of absolute aortic size.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Acute aortic dissection (AAD) often occurs with ascending aorta dilation below surgical thresholds.
- The aortic diameter to height index (AHI) is a proposed tool for risk stratification in AAD.
- Accurate risk assessment is crucial for timely prophylactic surgery in patients with aortic dilation.
Purpose of the Study:
- To evaluate the utility of AHI in risk stratification for patients with AAD.
- To determine if AHI can improve the identification of patients requiring intervention.
- To compare AHI in AAD patients versus a control group without aortic pathology.
Main Methods:
- Retrospective analysis of prospectively collected data from 210 AAD patients operated on between 2001 and 2023.
- Calculation of AHI for all AAD patients and a control group (n=6343).
- Risk modeling analysis and simulation of the dissecting process based on AHI.
Main Results:
- 80% of AAD patients had post-junctional aortic dilation; 25% had aortic diameter > 5.5 cm.
- AHI categorized patients into low (9%), moderate (67.6%), high (21.3%), and severe (2%) risk.
- Peak AHI for dissection was 2.93 cm/m (males) and 3.05 cm/m (females). Control group AHI was 2.01 cm/m.
- Simulations indicated 3.3% of patients had AHI ≥ 2.9 cm/m.
Conclusions:
- AHI revealed a significant prevalence of moderate risk in AAD patients.
- Patients with AHI exceeding 2.9 cm/m warrant referral to an aortic center for risk assessment.
- AHI provides valuable risk stratification for acute aortic dissection, independent of absolute aortic diameter.
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