Sex differences in ascending aortic diameter at the time of acute type A aortic dissection.

Modification of Penn Classification and Its Validation for Acute Type A Aortic Dissection

Commentary: Daytime or nighttime acute type A aortic dissection repair? Does it really matter?

Acute type A aortic dissection repair in octogenarians: Where are the “turn-down” data?

Commentary: No difference in postoperative surveillance between bicuspid aortic valve and tricuspid aortic valve patients after aortic surgery? Not so fast

Commentary: “How to Slay the Aortic Dissection Beast in a COVID-19 World”

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

Commentary: Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation: “A man's got to know his limitations”

AORTIC REMODELLING FOLLOWING HEMIARCH VERSUS EXTENDED ARCH REPAIR FOR ACUTE TYPE A AORTIC DISSECTION

Commentary: Open versus clamp-on distal anastomosis techniques in acute type A aortic dissection: The ship has already left the port

Recently, increased length of the ascending aorta has been suggested as a possible risk factor for acute type A aortic dissection (ATAAD). Our goal was to identify measurable aortic geometrical characteristics associated with elongation that could differentiate ATAAD from uncomplicated aortic dilation (>45 mm). In angiographic computed tomography scans performed in 180 patients having cardiac surgery, aortic diameters, root length, length of the ascending aorta at both the centreline and the greater curvature (convexity) and the root-ascending (root-asc) angle (that between the root axis and the axis of the ascending tract) and the ascending-arch (asc-arch) angle (that between the axis of the ascending aorta and the arch axis) were measured and compared among 3 patient groups: normal aorta (diameter < 45 mm), dilation/aneurysm (>45 mm) and ATAAD. Correlations between diameters and angles, diameters and lengths and lengths and angles were analysed; multivariable analysis including geometrical factors was performed to identify independent predictors of ATAAD. Both patients with aneurysms and patients with ATAAD showed significantly elongated ascending aortas (P < 0.001 vs normal). However, in the aneurysms, the root-asc angle (136° ± 20° vs 147° ± 17°; P < 0.001) and in ATAAD the asc-arch angle were uniquely narrower than that in the normal aorta (116° ± 11° vs 132° ± 19°; P < 0.001). All patients with an ATAAD had an asc-arch angle ≤130°. Both in patients with ATAAD and in those without ATAAD, narrowing of the asc-arch angle was associated with elongation of the root segment (P < 0.001). In multivariable analysis, the asc-arch angle and the total length of the ascending aorta (root + tubular) were significant predictors of ATAAD. The asc-arch angle is a promising measurement that could help predict aortic dissection along with aortic diameter and length: further verification is warranted.

Total fenestrated frozen elephant trunk technique for aortic repair of acute type A aortic dissection

Commentary: The DARTS (Dissected Aorta Repair Through Stent Implantation) trial: Hitting the bull's eye in acute type A aortic dissection?

Commentary: Contraventional wisdom: Primary management of lower-extremity malperfusion syndrome prior to ascending aortic repair in acute type A aortic dissection

ObjectiveThe main aim of this study is to measure and calculate the ratio of sinotubular junction diameter to body surface area (RDA) in patients with acute type A aortic dissection (ATAAD) and normal subjects, and to analyze the relationship between RDA and ATAAD to provide guidance for primary prevention of ATAAD.MethodsThis retrospective observational study totally admitted consecutive 320 patients with acute type A aortic dissection diagnosed in Nanjing First Hospital from March 2017 to March 2021. Meanwhile, 608 healthy subjects who took echocardiography examination in outpatient was selected as controls. The diameter of sinotubular junction (D.STJ) was measured using echocardiography and direct vision (in some ATAAD patients). The differences in body surface area (BSA), D.STJ and RDA index in both groups were assessed. The association between D.STJ and demographic characteristics were established. RDA index was used to distinguish the ATAAD and healthy subjects.ResultsThe diameter of STJ (24.41 ± 2.16 mm versus 26.66 ± 2.60 mm) and RDA index (13.16 ± 1.67 versus 15.40 ± 1.59) were significantly different between dissection group and control group. The D.STJ were found a positive, linear correlation to BSA in the healthy subjects. Multivariate logistic regression showed that RDA index was one of the independent risk factors to associated with ATAAD as a continuous variable (odds ratio (OR), 0.403, 95% confidence interval (CI): 0.352–0.457, P < 0.001) or a categorical variable (RDA cut-off: 13.88 mm/m2, OR, 0.070, 95%CI: 0.050–0.098, P < 0.001).ConclusionsRDA index is an independent and key risk factor for ATAAD occurrence. Timely identification of high-risk patients using RDA index has the potential to become an optional guidance for primary prevention of ATAAD.

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