BACKGROUND: Current guidelines recommend a diameter of 5-5.5 cm as the threshold for surgery on the ascending aorta. However, a study from the International Registry of Acute Aortic Dissection showed that nearly 60% occurred at <5.5 cm (the 'aortic size paradox')--leading to a debate whether the size threshold should be lowered. However, the study showing dissection at small size had no knowledge of the population at risk. Herein, we aim to calculate the relative risk of aortic dissection at sizes<5.5 cm by analyzing both the number of occurring dissections (numerator) and the population at risk at each aortic size (denominator). METHODS: Using a publicly available database of 3,573 multiethnic subjects (46% male, mean age 60.7 years) from the general population, we plotted a distribution curve of ascending aortic size (by magnetic resonance imaging). The relative risk of aortic dissection was calculated by dividing the proportion of dissections occurring at each size (numerator) by the proportion of aortas of that same size in the general population (denominator). RESULTS: The mean ascending aortic diameter of the reference population was 3.2 cm (±0.4 cm). The largest diameter was 4.9 cm in women and 5.0 cm in men. The proportion of subjects with an aorta <3.5 cm was 79.2%, that of subjects with 3.5-3.9 cm was 18.0%, that of subjects with 4.0-4.4 cm was 2.6%, and that of subjects with ≥4.5 cm was 0.22%. The relative risk of dissection in those categories was found to be 0.055, 2.5, 4.9, and 346.8, respectively. Patients with an aorta≥4.5 cm were 6,305 times more likely to suffer aortic dissection than those with an aorta<3.5 cm. CONCLUSIONS: The normal aorta is deceptively small, most commonly <3.5 cm. The aortic size paradox is a byproduct of the very large number of patients in small size ranges. This study fully supports current recommendations for surgical intervention at 5-5.5 cm.
BACKGROUND: Current guidelines recommend a diameter of 5-5.5 cm as the threshold for surgery on the ascending aorta. However, a study from the International Registry of Acute Aortic Dissection showed that nearly 60% occurred at <5.5 cm (the 'aortic size paradox')--leading to a debate whether the size threshold should be lowered. However, the study showing dissection at small size had no knowledge of the population at risk. Herein, we aim to calculate the relative risk of aortic dissection at sizes<5.5 cm by analyzing both the number of occurring dissections (numerator) and the population at risk at each aortic size (denominator). METHODS: Using a publicly available database of 3,573 multiethnic subjects (46% male, mean age 60.7 years) from the general population, we plotted a distribution curve of ascending aortic size (by magnetic resonance imaging). The relative risk of aortic dissection was calculated by dividing the proportion of dissections occurring at each size (numerator) by the proportion of aortas of that same size in the general population (denominator). RESULTS: The mean ascending aortic diameter of the reference population was 3.2 cm (±0.4 cm). The largest diameter was 4.9 cm in women and 5.0 cm in men. The proportion of subjects with an aorta <3.5 cm was 79.2%, that of subjects with 3.5-3.9 cm was 18.0%, that of subjects with 4.0-4.4 cm was 2.6%, and that of subjects with ≥4.5 cm was 0.22%. The relative risk of dissection in those categories was found to be 0.055, 2.5, 4.9, and 346.8, respectively. Patients with an aorta≥4.5 cm were 6,305 times more likely to suffer aortic dissection than those with an aorta<3.5 cm. CONCLUSIONS: The normal aorta is deceptively small, most commonly <3.5 cm. The aortic size paradox is a byproduct of the very large number of patients in small size ranges. This study fully supports current recommendations for surgical intervention at 5-5.5 cm.
Authors: Ayman A Saeyeldin; Camilo A Velasquez; Syed Usman B Mahmood; Adam J Brownstein; Mohammad A Zafar; Bulat A Ziganshin; John A Elefteriades Journal: Gen Thorac Cardiovasc Surg Date: 2017-12-04
Authors: Catherine Tcheandjieu; Ke Xiao; Helio Tejeda; Julie A Lynch; Sanni Ruotsalainen; Tiffany Bellomo; Madhuri Palnati; Renae Judy; Derek Klarin; Rachel L Kember; Shefali Verma; Aarno Palotie; Mark Daly; Marylyn Ritchie; Daniel J Rader; Manuel A Rivas; Themistocles Assimes; Philip Tsao; Scott Damrauer; James R Priest Journal: Nat Genet Date: 2022-05-30 Impact factor: 41.307
Authors: Michael A Borger; Paul W M Fedak; Elizabeth H Stephens; Thomas G Gleason; Evaldas Girdauskas; John S Ikonomidis; Ali Khoynezhad; Samuel C Siu; Subodh Verma; Michael D Hope; Duke E Cameron; Donald F Hammer; Joseph S Coselli; Marc R Moon; Thoralf M Sundt; Alex J Barker; Michael Markl; Alessandro Della Corte; Hector I Michelena; John A Elefteriades Journal: J Thorac Cardiovasc Surg Date: 2018-08 Impact factor: 5.209
Authors: Ayman Saeyeldin; Mohammad A Zafar; Camilo A Velasquez; Kevan Ip; Anton Gryaznov; Adam J Brownstein; Yupeng Li; John A Rizzo; Young Erben; Bulat A Ziganshin; John A Elefteriades Journal: Ann Cardiothorac Surg Date: 2017-11
Authors: Paris D Kalogerakos; Mohammad A Zafar; Yupeng Li; Sandip K Mukherjee; Bulat A Ziganshin; John A Rizzo; John A Elefteriades Journal: J Am Heart Assoc Date: 2021-07-09 Impact factor: 5.501
Authors: Katelyn Monaghan; Felix Orelaru; Aroma Naeem; Rana-Armaghan Ahmad; Xiaoting Wu; Karen M Kim; Shinichi Fukuhara; Himanshu J Patel; G Michael Deeb; Bo Yang Journal: Cardiol Cardiovasc Med Date: 2021-12-03