Combining Ascending Aortic Diameter and Length and Their Growth Rates Improves the Prediction of Type A Aortic...

Area of Science:

• Cardiovascular Surgery
• Aortic Diseases
• Medical Imaging

Background:

• Acute type A aortic dissection (ATAAD) is a life-threatening condition.
• Current surgical guidelines for ATAAD prevention are based on ascending aortic dimensions.
• Many ATAAD cases occur below these established thresholds.

Purpose of the Study:

• To investigate the risk of ATAAD based on ascending aortic diameter, length, and their growth rates.
• To develop a risk assessment tool for ATAAD.
• To evaluate the adequacy of current preventive surgery thresholds.

Main Methods:

• Ascending aortic diameters and lengths were measured using serial CT and MRI.
• Growth patterns and rates were analyzed prior to ATAAD onset.
• A risk function was developed using these measurements and growth rates.

Main Results:

• In 116 patients, 30 had ATAAD and 86 did not.
• Nearly half of ATAAD patients (46.7%) were below current dimension-based surgical thresholds.
• A diameter growth rate of 3 mm/year was rare (2.6%).
• The developed risk function predicted 5-year ATAAD risk with high confidence (AUC 0.83).

Conclusions:

• Combining ascending aortic diameter, length, and growth rates improves ATAAD risk assessment.
• Current thresholds based solely on dimensions are insufficient for many ATAAD cases.
• Preventive surgery guidelines may need to incorporate all four parameters: diameter, length, and their growth rates.