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(Circulation. 2007;116:1120-1127.)
© 2007 American Heart Association, Inc.

Cardiovascular Surgery

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)

Linda A. Pape, MD; Thomas T. Tsai, MD; Eric M. Isselbacher, MD; Jae K. Oh, MD; Patrick T. O’Gara, MD; Arturo Evangelista, MD; Rossella Fattori, MD; Gabriel Meinhardt, MD; Santi Trimarchi, MD; Eduardo Bossone, MD; Toru Suzuki, MD; Jeanna V. Cooper, MS; James B. Froehlich, MD, MPH; Christoph A. Nienaber, MD; Kim A. Eagle, MD, on behalf of the International Registry of Acute Aortic Dissection (IRAD) Investigators

From the University of Massachusetts Medical School (L.A.P.), Worcester, Mass; University of Michigan (T.T.T., J.V.C., J.B.F., K.A.E.), Ann Arbor, Mich; Massachusetts General Hospital (E.M.I.), Boston, Mass; Mayo Clinic (J.K.O.), Rochester, Minn; Brigham and Women’s Hospital (P.T.O.), Boston, Mass; Hospital General Universitari Vall d’Hebron (A.E.), Barcelona, Spain; University Hospital S. Orsola (R.F.), Bologna, Italy; Robert-Bosch Krankenhaus (G.M.), Stuttgart, Germany; Istituto Policlinico San Donato (S.T.), San Donato Milanese, Italy; National Research Council (E.B.), Lecce, Italy; University of Tokyo (T.S.), Tokyo, Japan; University Hospital Rostock (C.A.N.), Rostock, Germany.

Correspondence to Dr Linda Pape, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655. E-mail linda.pape{at}umassmed.edu

Received March 16, 2007; accepted July 3, 2007.

Background— Studies of aortic aneurysm patients have shown that the risk of rupture increases with aortic size. However, few studies of acute aortic dissection patients and aortic size exist. We used data from our registry of acute aortic dissection patients to better understand the relationship between aortic diameter and type A dissection.

Methods and Results— We examined 591 type A dissection patients enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2005 (mean age, 60.8 years). Maximum aortic diameters averaged 5.3 cm; 349 (59%) patients had aortic diameters <5.5 cm and 229 (40%) patients had aortic diameters <5.0 cm. Independent predictors of dissection at smaller diameters (<5.5 cm) included a history of hypertension (odds ratio, 2.17; 95% confidence interval, 1.03 to 4.57; P=0.04), radiating pain (odds ratio, 2.08; 95% confidence interval, 1.08 to 4.0; P=0.03), and increasing age (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05; P=0.03). Marfan syndrome patients were more likely to dissect at larger diameters (odds ratio, 14.3; 95% confidence interval, 2.7 to 100; P=0.002). Mortality (27% of patients) was not related to aortic size.

Conclusions— The majority of patients with acute type A acute aortic dissection present with aortic diameters <5.5 cm and thus do not fall within current guidelines for elective aneurysm surgery. Methods other than size measurement of the ascending aorta are needed to identify patients at risk for dissection.

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