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Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters.

Publication ,  Journal Article
Ganapathi, AM; Ranney, DN; Peterson, MD; Lindsay, ME; Patel, HJ; Pyeritz, RE; Trimarchi, S; Hutchison, S; Harris, KM; Greason, KL; Ota, T ...
Published in: J Am Coll Cardiol
May 17, 2022

BACKGROUND: Previous work has demonstrated that more than one-half of acute type A aortic dissections (ATADs) occur at a maximal aortic diameter (MAD) of <5.5 cm. However, no analysis has investigated whether ATAD risk at smaller MADs is more common with modest dilation of the aortic root (AR) or supracoronary ascending aorta (AA) in patients without genetically triggered aortopathy. OBJECTIVES: This study sought to determine if the segment of modest aortic dilation affects risk of ATAD. METHODS: Using the International Registry of Acute Aortic Dissection (IRAD) database from May 1996 to October 2016, we identified 667 ATAD patients with MAD <5.5 cm. Patients were stratified by location of the largest proximal aortic segment (AR or AA). Patients with known genetically triggered aortopathy were excluded. MADs at time of dissection were compared between AR and AA groups. Secondary outcomes included operation, postoperative outcomes, and long-term survival. RESULTS: Of patients with ATAD at an MAD <5.5 cm, 79.5% (n = 530) were in the AA group and 20.5% (n = 137) in the AR group. Modestly dilated ARs (median MAD 4.6 cm [IQR: 4.1-5.0 cm]) dissected at a significantly smaller diameter than modestly dilated AAs (median MAD 4.8 cm [IQR: 4.4-5.1 cm]) (P < 0.01). AR patients were significantly younger than AA patients (58.5 ± 13.0 years vs 63.2 ± 13.3 years; P < 0.01) and more commonly male (78% vs 65%; P < 0.01). Postoperative and long-term outcomes did not differ between groups. CONCLUSIONS: ATAD appears to occur at smaller diameters in patients with modest dilation in the AR vs the AA (4.6 vs 4.8 cm). These findings may have implications for future consensus guidelines regarding the management of patients with aortic disease.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 17, 2022

Volume

79

Issue

19

Start / End Page

1890 / 1897

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Registries
  • Male
  • Humans
  • Cardiovascular System & Hematology
  • Aortic Dissection
  • Aortic Diseases
  • Aorta
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Ganapathi, A. M., Ranney, D. N., Peterson, M. D., Lindsay, M. E., Patel, H. J., Pyeritz, R. E., … Hughes, G. C. (2022). Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters. J Am Coll Cardiol, 79(19), 1890–1897. https://doi.org/10.1016/j.jacc.2022.02.053
Ganapathi, Asvin M., David N. Ranney, Mark D. Peterson, Mark E. Lindsay, Himanshu J. Patel, Reed E. Pyeritz, Santi Trimarchi, et al. “Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters.J Am Coll Cardiol 79, no. 19 (May 17, 2022): 1890–97. https://doi.org/10.1016/j.jacc.2022.02.053.
Ganapathi AM, Ranney DN, Peterson MD, Lindsay ME, Patel HJ, Pyeritz RE, et al. Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters. J Am Coll Cardiol. 2022 May 17;79(19):1890–7.
Ganapathi, Asvin M., et al. “Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters.J Am Coll Cardiol, vol. 79, no. 19, May 2022, pp. 1890–97. Pubmed, doi:10.1016/j.jacc.2022.02.053.
Ganapathi AM, Ranney DN, Peterson MD, Lindsay ME, Patel HJ, Pyeritz RE, Trimarchi S, Hutchison S, Harris KM, Greason KL, Ota T, Montgomery DG, Nienaber CA, Eagle KA, Isselbacher EM, Hughes GC. Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters. J Am Coll Cardiol. 2022 May 17;79(19):1890–1897.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 17, 2022

Volume

79

Issue

19

Start / End Page

1890 / 1897

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Registries
  • Male
  • Humans
  • Cardiovascular System & Hematology
  • Aortic Dissection
  • Aortic Diseases
  • Aorta
  • 3201 Cardiovascular medicine and haematology