| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1999;67:1922-1926
© 1999 The Society of Thoracic Surgeons
a Section of Cardiothoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
b Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
Address reprint requests to Dr Elefteriades, Section of Cardiothoracic Surgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510
e-mail: john_elefteriades{at}QM.yale.edu
Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.
Background. Evidence regarding the behavior of thoracic aortic aneurysm (TAA) is limited. This study reviews our ongoing efforts to understand the factors influencing aortic growth rates and the complications of rupture and dissection in order to define scientifically sound criteria for surgical intervention.
Methods. Data from 370 patients with TAA treated at Yale University School of Medicine from January 1985 to June 1997 were analyzed. This computerized data base included 1063 imaging studies (magnetic resonance imaging, computed tomography, and echocardiography).
Results. The mean size of the thoracic aorta in these patients at initial presentation was 5.2 cm (range 3.5–10). The mean growth rate was 0.10 cm/year. Median size at the time of rupture or dissection was 5.9 cm for ascending and 7.2 cm for descending aneurysms. The incidence of dissection or rupture increased with aneurysm size. Multivariable regression analysis to isolate risk factors for acute dissection or rupture revealed that size 
6.0 cm increased the probability of these devastating complications by 25.2% for ascending aneurysms (p = 0.006 compared with aneurysms 4.0–4.9 cm). For descending aneurysms 7.0 cm, risk of dissection or rupture was increased by 37.3% (p = 0.031).
Conclusions. If the median size at time of dissection or rupture had been used as the indication for intervention, half the patients would have suffered a devastating complication before surgery. Accordingly, a criterion lower than the median is appropriate. We recommend 5.5 cm as an acceptable size for elective resection of ascending aortic aneurysms because this operation can be performed with relatively low mortality. For aneurysms of the descending aorta, where perioperative complications are greater and the median size at the time of complication is larger, we recommend intervention at 6.5 cm.
This article has been cited by other articles:
|
|
 |
|
  L. M. Parish, J. H. Gorman III, S. Kahn, T. Plappert, M. G. St. John-Sutton, J. E. Bavaria, and R. C. Gorman Aortic size in acute type A dissection: implications for preventive ascending aortic replacement Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 941 - 946. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. P. Agarwal, A. Chughtai, F. R. K. Matzinger, and E. A. Kazerooni Multidetector CT of Thoracic Aortic Aneurysms RadioGraphics, March 1, 2009; 29(2): 537 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): 1890 - 1947. [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): e714 - e833. [Full Text] [PDF]
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): 2395 - 2451. [Full Text] [PDF]
|
|
|
|
|
|
O. E. Dapunt, J. Easo, P. P.F. Holzl, P. Murin, M. Sudkamp, M. Horst, and E. Natour Stentless full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 554 - 559. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Conrad and R. P. Cambria Contemporary Management of Descending Thoracic and Thoracoabdominal Aortic Aneurysms: Endovascular Versus Open Circulation, February 12, 2008; 117(6): 841 - 852. [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. David Aortic Valve Repair and Aortic Valve Sparing Operations Card. Surg. Adult, January 1, 2008; 3(2008): 935 - 948. [Full Text]
|
|
|
|
|
|
D. R. Brinster, R. J. Rizzo, and R. M. Bolman III Ascending Aortic Aneurysms Card. Surg. Adult, January 1, 2008; 3(2008): 1223 - 1250. [Full Text]
|
|
|
|
 |
|
 L. G. Svensson, N. T. Kouchoukos, D. C. Miller, J. E. Bavaria, J. S. Coselli, M. A. Curi, H. Eggebrecht, J. A. Elefteriades, R. Erbel, T. G. Gleason, et al. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts Ann. Thorac. Surg., January 1, 2008; 85(1_Supplement): S1 - S41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Pape, T. T. Tsai, E. M. Isselbacher, J. K. Oh, P. T. O'Gara, A. Evangelista, R. Fattori, G. Meinhardt, S. Trimarchi, E. Bossone, et al. Aortic Diameter >=5.5 cm Is Not a Good Predictor of Type A Aortic Dissection: Observations From the International Registry of Acute Aortic Dissection (IRAD) Circulation, September 4, 2007; 116(10): 1120 - 1127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Zierer, R. K. Voeller, K. E. Hill, N. T. Kouchoukos, R. J. Damiano Jr, and M. R. Moon Aortic Enlargement and Late Reoperation After Repair of Acute Type A Aortic Dissection Ann. Thorac. Surg., August 1, 2007; 84(2): 479 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Ejiri, N. Inoue, T. Tsukube, T. Munezane, Y. Hino, S. Kobayashi, K.-i. Hirata, S. Kawashima, S. Imajoh-Ohmi, Y. Hayashi, et al. Oxidative stress in the pathogenesis of thoracic aortic aneurysm: Protective role of statin and angiotensin II type 1 receptor blocker Cardiovasc Res, October 1, 2003; 59(4): 988 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Svensson, K.-H. Kim, B. W. Lytle, and D. M. Cosgrove Relationship of aortic cross-sectional area to height ratio and the risk of aortic dissection in patients with bicuspid aortic valves J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 892 - 893. [Full Text] [PDF]
|
|
|
|
|
|
M. Doss, J. Balzer, S. Martens, J. P. Wood, G. Wimmer-Greinecker, A. Moritz, and H.-G. Fieguth Emergent endovascular stent grafting for perforated acute type B dissections and ruptured thoracic aortic aneurysms Ann. Thorac. Surg., August 1, 2003; 76(2): 493 - 498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Bethuyne, T. Bove, P. Van den Brande, and J. P. Goldstein Acute retrograde aortic dissection during endovascular repair of a thoracic aortic aneurysm Ann. Thorac. Surg., June 1, 2003; 75(6): 1967 - 1969. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Codecasa, M. A. Mariani, A. D'Alfonso, C. Nardi, and J. G. Grandjean Current indications for elective surgical treatment of dilated ascending aorta: A new formula J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1528 - 1530. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schoder, F. Cartes-Zumelzu, M. Grabenwoger, M. Cejna, M. Funovics, C. G. Krenn, D. Hutschala, F. Wolf, S. Thurnher, G. Kretschmer, et al. Elective Endovascular Stent-Graft Repair of Atherosclerotic Thoracic Aortic Aneurysms:Clinical Results and Midterm Follow-Up Am. J. Roentgenol., March 1, 2003; 180(3): 709 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Anderson, R. J. Rizzo, and L. H. Cohn Ascending Aortic Aneurysms Card. Surg. Adult, January 1, 2003; 2(2003): 1123 - 1148. [Full Text]
|
|
|
|
|
|
U. Herold, J. Piotrowski, D. Baumgart, H. Eggebrecht, R. Erbel, and H. Jakob Endoluminal stent graft repair for acute and chronic type B aortic dissection and atherosclerotic aneurysm of the thoracic aorta: an interdisciplinary task Eur. J. Cardiothorac. Surg., December 1, 2002; 22(6): 891 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S M Thomas The current role of catheter angiography Imaging, December 15, 2001; 13(5): 366 - 375. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
