that one is by: Matthew D. Solomon, MD, PhD1,2; Thomas Leong, MPH1; Sue Hee Sung, MPH1; et al
Not sure who Kim is .. though I did see him cited and in the references ...
I thought I'd reformat this for readability
Larger initial aortic size was associated with higher risk of AD and all-cause death in multivariable models, with an inflection point in risk at 6.0 cm.
Estimated adjusted risks of AD within 5 years were:
- 4.0 to 4.4 cm - 0.3% (95% CI, 0.3-0.7) ,
- 4.5 to 4.9 cm - 0.6% (95% CI, 0.4-1.3) ,
- 5.0 to 5.4 cm - 1.5% (95% CI, 1.2-3.9) ,
- 5.5 to 5.9 cm - 3.6% (95% CI, 1.8-12.8), and
- > 6.0 cm 10.5% (95% CI, 2.7-44.3)
Rates of the composite outcome of AD and all-cause death were higher than for AD alone, but a similar inflection point for increased risk was observed at 6.0 cm.
Our data support current consensus guidelines recommending prophylactic surgery in nonsyndromic individuals with TAA at a 5.5-cm threshold.
In this study seems the risk of dissection is so low till 6cm.
I don't see that as low, even considering that I ride a motorcycle.
they support the consensus guidelines:
Further and getting back to:
https://www.sciencedirect.com/science/article/pii/S1936878X13006724
Aortic Surgery for Ascending Aortic Aneurysms Under 5.0 cm in Diameter in the Presence of Bicuspid Aortic Valve
The title itself was enough to ask "are you BAV"? I don't see much in your bio
It matters because as discussed here:
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106
3. There are additional risk factors for aortic dissection that may inform aortic surgical thresholds in patients with a BAV. A family history of aortic dissection10 and rapid aortic growth of ≥0.3 cm/y (when measured similarly with same technique) are both risk factors for aortic dissection. Patients with BAV and aortic coarctation have been reported to be at increased risk of aortic dissection,11 although in a recent report of 499 patients with BAV (mean age, 40±16 years), of whom 24% also had aortic coarctation, there was no difference in adverse aortic events between those with or without coarctation.12 Patients with dilation of the aortic root (“root phenotype”) represent 10% to 20% of patients with BAV and aortopathy and may have more rapid aortic growth and an increased risk of aortic complications.13,14 Because surgical aortic root replacement (and VSRR) is more complex than ascending aortic replacement, shared decision-making is often used when evaluating the risks and benefits of elective aortic root replacement at aortic diameters <5.5 cm.1,2,5,6
4. In patients with a BAV and indications for aortic valve intervention for stenosis or regurgitation, the data are limited regarding the degree of aortic dilation that warrants replacement of the aortic root, ascending aorta, or both at the time of AVR. Patients with a long life expectancy, low surgical risk, or with the root phenotype and predominant AR may benefit from concomitant prophylactic aortic repair. Conversely, for patients at higher surgical risk, especially those with aortic stenosis and only moderate ascending aortic dilation, the risks of concomitant aortic repair may not be warranted.
5. Limited data are available on the risk of aortic dissection among those with a BAV and aortic aneurysm diameter of 5.0 cm to 5.4 cm.5,15 Patient-related characteristics and surgical expertise may inform the timing of surgery, especially in low-risk patients with BAV and aortic aneurysms of 5.0 cm to 5.4 cm.1,2,5,6
HTH
