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Original research article
Aortic elongation part II: the risk of acute type A aortic dissection
  1. Samuel Heuts1,2,
  2. Bouke P Adriaans2,3,4,
  3. Suzanne Gerretsen4,
  4. Ehsan Natour1,5,
  5. Rein Vos6,
  6. Emile C Cheriex3,
  7. Harry J G M Crijns2,3,
  8. Joachim E Wildberger2,4,
  9. Jos G Maessen1,2,
  10. Simon Schalla2,3,4,
  11. Peyman Sardari Nia1,2
  1. 1Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
  2. 2Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Limburg, The Netherlands
  3. 3Department of Cardiology, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
  4. 4Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
  5. 5Department of Thoracic and Cardiovascular Surgery, Uniklinik RWTH Aachen, Aachen, Germany
  6. 6Department of Methodology and Statistics, Maastricht University, Maastricht, Limburg, The Netherlands
  1. Correspondence to Samuel Heuts, Department of Cardiothoracic Surgery, Maastricht University Medical Center, 6229HX, Maastricht, The Netherlands; sam.heuts{at}mumc.nl

Abstract

Objectives Prophylactic surgery for prevention of acute type A aortic dissection (ATAAD) is reserved for patients with an ascending aortic aneurysm ≥55 mm. Identification of additional risk predictors is warranted since over 70% of patients presenting with ATAAD have a non-dilated aorta or an aneurysm that would not have met the diameter criterion for preventative surgery. Aim of the study was to evaluate ascending aortic elongation as a risk factor for ATAAD and to compare aortic lengths between ATAAD patients and healthy controls.

Methods Aortic lengths and diameters of ATAAD patients were measured on three-dimensional modelled computed tomography and adjusted to predissection dimensions in this cross-sectional single-centre study. Logistic regression was used to evaluate the relation between ATAAD and aortic dimensions. Lengths of different aortic segments were compared with a healthy control group using propensity score matching.

Results Two-hundred and fifty patients were included in the study (ATAAD, n=40; controls, n=210). Ascending aortic length and diameter proved to be independent predictors for ATAAD (OR=5.3, CI 2.5 to 11.4, p<0.001 and OR=8.6, CI 2.4 to 31.0, p=0.001). Eighty patients were matched based on propensity scores (ATAAD n=40, controls n=40). The ascending aorta was longer and more dilated in ATAAD patients compared with healthy controls (78.6±8.8 mm vs 68.9±7.2 mm, p<0.001, 34.4 mm ±3.2. vs 39.4 mm ±5.7, p<0.001, respectively). No differences were found in lengths of the aortic arch and descending aorta.

Conclusions Ascending aortic length could serve as an independent predictor for ATAAD. Future studies addressing indications for prophylactic surgery should also investigate aortic length.

  • aortic dissection or intramural hematoma
  • aortic aneurysm
  • aortic and arterial disease
  • aortic surgery
  • cardiac computer tomographic (ct) imaging

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Footnotes

  • Contributors SH, BPA: conceptualisation, data acquisition, data analysis, data interpretation, drafting and writing of the manuscript, final approval and agreement to be accountable for all aspects of the work. SG: data acquisition, data interpretation, drafting and writing of the manuscript, final approval and agreement to be accountable for all aspects of the work. EN, HJGMC, JGM: conceptualisation, data interpretation, manuscript review, final approval and agreement to be accountable for all aspects of the work. RV: data analysis, data interpretation, drafting and writing of the manuscript, final approval and agreement to be accountable for all aspects of the work. ECC: conceptualisation, data acquisition, manuscript review, final approval and agreement to be accountable for all aspects of the work. JEW, SS, PSN: conceptualisation, data interpretation, drafting and writing of the manuscript, final approval and agreement to be accountable for all aspects of the work.

  • Funding This work is supported by Stichting de Weijerhorst, Maastricht, Limburg, the Netherlands.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Medical Ethical Review Board, Maastricht University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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