Abstract 18778: Should Ascending Aorta Replacement be Performed at 5cm for Prevention of Type A Dissection? Real World Data Analysis of Aortic Diameters in both Elective and Emergent Settings
Background: Surgical repair of acute type A dissection(Type A) is associated with significant operative risk and is reported to be as high as 30%. Preventative measures to minimize occurrence of Type A include anti-impulse therapy and elective replacement of ascending aortic aneurysms (Asc). Current guidelines recommend elective Asc replacement at ≥5.5cm; however, average Asc size at the time of Type A is relatively unknown. In high volume aortic centers elective Asc replacement can be achieved with low operative risk. This study compared aortic diameters and mortality in patients (pts) undergoing elective and emergent proximal aortic replacement.
Methods: A retrospective review from January 2004-May 2010 was performed for pts undergoing Asc replacement both electively and at the time of Type A. 381 pts had surgery for Type A and 354 pts underwent elective Asc repair. CT scan and TEE were used to measure Asc diameters in both groups. Aortic sizes were obtained in 135 Type A and 354 elective cases.
Results: Type A pts had significantly higher incidences of hypertension (78.6% vs. 69.3%, p=0.031) and CHF (49.5% vs. 27%, p<0.001) than elective pts, but lower levels of diabetes (5.7% vs. 11.5%, p=0.042). Average Asc diameter in Type A pts(4.9 cm, Range 2.7–9 cm) was significantly smaller than the diameter(5.6 cm) in elective pts(p<0.001). In the Type A group, aortic size was <5.5 cm in 70% of pts, <5 cm in 49% and <4.5 cm in 33%. Root replacement was performed in 114(30%) Type A pts and 225(64%) elective pts. Mortality in elective pts(2.5%) was significantly lower than in Type A pts(17%, p<0.001).
Conclusions: Acute type A dissection is associated with significantly higher operative mortality than elective Asc repair. The average aortic diameter at the time of Type A is <5cm and, in the majority of circumstances, is <5.5cm. These data suggest that in high volume aortic surgery centers, Asc replacement should be considered at diameters of ≥5 cm, particularly in the presence of hypertension.
- © 2010 by American Heart Association, Inc.