Indications for ascending and arch aortic aneurysm repair

Aneurysm type/associated condition	Aneurysm diameter^*
Sporadic (not associated with disease below)
Ascending	≥5.5 cm >5.0 cm (ACOE and low operative risk)
Isolated arch aneurysm	≥5.5 cm
Marfan syndrome (MFS), familial thoracic aortic aneurysm/dissection (FTAAD), others^¶
Without risk factors^Δ◊	≥5.0 cm
With risk factors^Δ◊	≥4.5 cm
Loeys-Dietz syndrome (LDS)
Without risk factors^Δ◊	≥4.5 cm
With risk factors^Δ◊	≥4.0 cm
Bicuspid aortic valve (BAV)
Without risk factors^Δ◊	≥5.5 cm >5.0 cm (ACOE and low operative risk)
With risk factors^Δ◊	≥5.0 cm
Concomitant aortic valve surgery	≥4.5 cm

The aortic diameter values provided in the table are those suggested by expert consensus. Determining the optimal timing for elective TAA repair can be challenging and requires clinical judgment taking into account the patient's age, comorbidities, the rate of aortic expansion, other indications for surgery (eg, aortic valve pathology), and body habitus, among others. In addition, not every syndrome has been identified or characterized genetically, so there may be young individuals who do not obviously have degenerative TAA and will require an individualized approach. Refer to the discussion in the UpToDate topics discussing TAA.

ACOE: aortic center of excellence; EDS: Ehlers-Danlos syndrome; TAA: thoracic aortic aneurysm; TGFBR2: transforming growth factor beta receptor 2.

* A threshold cross-sectional area of the ascending aorta area or aortic root adjusted for the patient's height of ≥10 cm²/m may be helpful for identifying candidates for prophylactic aortic repair among individuals with taller or shorter than average stature (ie, >1 standard deviation above or below the mean).

¶ Others include Turner syndrome and other non-BAV congenital conditions. It is unclear when to intervene for EDS; some suggest surgery for acute events only.

Δ Risk factors for aortic complications include family history of dissection, progressive aortic regurgitation, and aortic expansion by 0.3 cm or more per year. For LDS, additional risk factors include female sex and TGFBR2 mutations. For BAV, additional risk factors include aortic coarctation and "root phenotype" aortopathy. For Turner syndrome, an additional risk factor is aortic coarctation. For Marfan syndrome, patient preference may inform a decision for aortic surgery before pregnancy when the aortic diameter is <4.5 cm.

◊ For those with rapid expansion (increase by 0.5 cm or more per year), a lower diameter may be warranted (eg, 5.0 cm for sporadic TAA).

References:

Hisselbacher, EM Preventza O, Black 3rd JH, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146:e334.
Hiratzka LF, Creager MA, Isselbacher EM, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: A statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; 67:724.
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2873.

Graphic 115163 Version 6.0

خرید پکیج

Indications for ascending and arch aortic aneurysm repair