gsl1956
Member
In the Jan. 2018 edition of the medical journal Cardiology, Dr. John Elefteriades and colleagues published a new study on aortic dissection and diamter size. The Report is entitled “Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention.” I’ am curious if others on the forum are aware of this or if their cardiothoracic surgeon’s have alluded to it. Dr. Elefteriades of Yale is one of the pioneers of modern aortic research for the past 30 years and is highly influential in the medical community. The results from this study seems like a game-changer to me.
Here is link to the report: https://www.researchgate.net/publica...r_Intervention
Their research shows that “the aortic diameter increases substantially due to aortic dissection itself and, thus, aortas are being dissected at clinically meaningfully smaller sizes than natural history analyses have previously suggested. These findings have important implications regarding the size at which the risk of dissection is increased.”
His research also revealed that the significant impact of the dissection itself causes an estimated increase at onset in size of 7.65 mm (ascending aorta) and 6.38 mm (descending aorta). It says the mean aortic sizes at and immediately prior to dissection were 54.2 ± 7.0 mm and 45.1 ± 5.7 mm for the ascending aorta, and 47.1 ± 13.8 and 39.5 ± 13.1 mm for the descending aorta, respectively. Since most historical studies on the risk of dissection have relied on aortic diamter measurement from post-dissection imaging, it seems that all the guidelines for the timing of surgical intervention are significantly skewed too high - at least by 7.65 mm for ascending aortas. Hence, this paper suggest we need to lower the aortic diamter size threshold downward from the 2010 ACC guidelines of 5.5 cm standard and 5.0 or less for syndromes/connective tissue disorders.
I’ am a patient with a 4.6 cm ascending aortic aneurysm with a known family history of thoracic aortic dissection and also have a COL3A1 gene variant of unknown significance. If what this paper holds true, then someone at my diameter size is now in that zone of elevated risk of dissection. I’m going to be reaching out my cardiothoracic surgeon, Dr. Girardi at Weill Cornell, to get his perspective on this.
Finally, it appears from this study that much of the prior 2010 guidance on dissection risk and resulting treatment protocols are founded on a faulty assumption that the aortic diameter immediately prior to dissection was not significantly different than post-dissection. This study seems to completely debunk that. Seems the aortic experts need to go back to the drawing board on the protocol for surgical intervention vs. watchful waiting.
Welcome your comments or questions. Thanks.
Here is link to the report: https://www.researchgate.net/publica...r_Intervention
Their research shows that “the aortic diameter increases substantially due to aortic dissection itself and, thus, aortas are being dissected at clinically meaningfully smaller sizes than natural history analyses have previously suggested. These findings have important implications regarding the size at which the risk of dissection is increased.”
His research also revealed that the significant impact of the dissection itself causes an estimated increase at onset in size of 7.65 mm (ascending aorta) and 6.38 mm (descending aorta). It says the mean aortic sizes at and immediately prior to dissection were 54.2 ± 7.0 mm and 45.1 ± 5.7 mm for the ascending aorta, and 47.1 ± 13.8 and 39.5 ± 13.1 mm for the descending aorta, respectively. Since most historical studies on the risk of dissection have relied on aortic diamter measurement from post-dissection imaging, it seems that all the guidelines for the timing of surgical intervention are significantly skewed too high - at least by 7.65 mm for ascending aortas. Hence, this paper suggest we need to lower the aortic diamter size threshold downward from the 2010 ACC guidelines of 5.5 cm standard and 5.0 or less for syndromes/connective tissue disorders.
I’ am a patient with a 4.6 cm ascending aortic aneurysm with a known family history of thoracic aortic dissection and also have a COL3A1 gene variant of unknown significance. If what this paper holds true, then someone at my diameter size is now in that zone of elevated risk of dissection. I’m going to be reaching out my cardiothoracic surgeon, Dr. Girardi at Weill Cornell, to get his perspective on this.
Finally, it appears from this study that much of the prior 2010 guidance on dissection risk and resulting treatment protocols are founded on a faulty assumption that the aortic diameter immediately prior to dissection was not significantly different than post-dissection. This study seems to completely debunk that. Seems the aortic experts need to go back to the drawing board on the protocol for surgical intervention vs. watchful waiting.
Welcome your comments or questions. Thanks.
