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Dissection dimensions differ: Global variability in ascending aortic size challenges universal surgical thresholds.

Nimrat Grewal1,2, Nora Bacour1, Mohammad Zafar2

  • 1Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.

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|June 17, 2026
PubMed
Summary
This summary is machine-generated.

Ascending aortic dimensions in acute type A aortic dissection (ATAAD) vary significantly by ethnicity and sex. Most dissections occur below current surgical thresholds, suggesting a need for personalized risk assessment.

Keywords:
aortic dissectionascending aortageographic variationrisk stratificationsex differencessurgical thresholds

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Area of Science:

  • Cardiovascular Surgery
  • Aortic Diseases
  • Medical Imaging

Background:

  • Current surgical thresholds for ascending aortic replacement are based on Western, male-predominant populations.
  • The applicability of these thresholds across diverse ethnic and geographic groups is uncertain.
  • Acute type A aortic dissection (ATAAD) necessitates understanding variations in aortic dimensions.

Purpose of the Study:

  • To evaluate global and sex-specific variability in ascending aortic dimensions at the time of ATAAD.
  • To determine if current surgical thresholds are universally applicable.
  • To inform population- and sex-specific approaches to aortic risk assessment.

Main Methods:

  • Retrospective analysis of 1388 surgically treated ATAAD patients from four international cohorts (Netherlands, US, Austria, India).
  • Ascending aortic diameters measured using preoperative contrast-enhanced computed tomography scans.
  • Multivariable linear regression adjusted for age, sex, body surface area, hypertension, and diabetes.

Main Results:

  • Indian patients presented with ATAAD over a decade earlier than Western cohorts (48.5 vs. ~63 years).
  • Women presented later than men (68 vs. 59 years) but had smaller ascending aortic diameters (46.0 vs. 48.4 mm).
  • Country of origin independently predicted aortic size; Indian, American, and Austrian cohorts had larger diameters than the Dutch cohort. Only 19.5% dissected at diameters ≥55 mm, while 39.7% presented between 45-54 mm.

Conclusions:

  • Ascending aortic dimensions at ATAAD show substantial variation by sex and geographic origin.
  • The majority of dissections occur below current surgical diameter thresholds, indicating absolute diameter alone is insufficient for risk assessment.
  • Findings challenge the universality of fixed surgical cut-offs and support personalized approaches to aortic risk stratification.