What about the Aortic Size / Body Surface Calculation?

[MrP]

Perhaps I overlooked it, but the article you referenced, although really an excellent article, did not mention that for those who undergo successful elective aortic valve replacement and aneurysm resection, their lifespan is pretty equivalent to a normal lifespan. In contrast, similar patients who require emergency surgery due to dissection or rupture are at increased risk after surgery of a less than normal lifespan.

So, by waiting in the gray area with increased risk of dissection and rupture as time goes forward to the "statistical edgepoint", one must ask, "how lucky do I feel?"

All my best, MrP
MrP

 

[Reddog]

Is it better to have the whole thing big? Can someone explain? Or is it bad if your whole aorta is dilated?!

There are three calculations that I've heard that cardiac surgeons use to to determine when it's time to cut.

1) The first is maximum aortic diameter.

2) The second is ratio of maximum aortic diameter to body surface area.

3) The third is the ratio of the maximum diameter of the aortic root and ascending aorta to the diameter of the descending aorta. For someone with a bicuspid valve, your entire ascending aorta may be dilated. It is far less common that the descending aorta is dilated so this last ratio gives you a sense of how far out of whack the ascending aneurism is. My understanding is that typically a CT scan or MRI is required to find this out.

So in answer to your question... it's not better if your whole ascending aorta is dilated, but if the descending aorta is large, it may signal that you are a big guy with big blood vessels. That's something to discuss with your surgeon.

Red

 

[lucky401]

Just thought I would chime in. My aneurysm was at 4.0 when I had my surgery. I am 4' 11" and weigh 120 pounds. My surgeon said he would replace the aorta along with my aortic valve because at my small size he felt the 4.0 was dangerous for me. He seemed to feel it was all relative.

Barb

 

[Equusz]

I'm catching this thread a bit late because I just joined, but I also found that article and instead of making a new post about it, though I would add to this one.

More importantly, I think, than this article, is the 2005 Yale clinical study cited in the article about relative body size to rupture correlation, as others have mentioned here. This is a peer-reviewed and published study and I'm wondering if people who seem to be dismissing it as a "formula" have actually read the study itself and not just the abstract (which is located here). I'm thinking of buying it and reading it myself to find out a) if it's a one-time risk of rupture if the aneurysm stays the same size, or an annual-risk as someone else mentioned. According to their study, my 4.5 cm ascending aorta puts me in the "low" risk at "4% per year". Does that mean that the risk of someone at 4.5cm has a 40% chance of rupture across 10 years, even if stays the same? That doesn't seem "low-risk" to me at all. But it could mean that it's 4% and that's it. Big difference.

I'd also like to know if the patients in the study were under treatment (BP control, etc) for their treatments and if any of them were weighted according to comorbid factors like Marfan's or BAV.

Has anyone read the whole thing? I may just buy it after I talk to my cardio and Stanford.

 

[DavesMom]

Mine calculates to 3.4 so according to this formula I'm in the "moderate" group. I'm very small so do worry that my size puts me at an even greater risk. My cardio mentioned the 5.0 cm threshold for surgery (even with my BAV!) during my last visit and I handed her an article about this. I'm not sure if she read it or not - I'll see her in a couple of months and will ask.

Interesting questions you raised.

Cheers,
Michelle

 

[delvalle6]

formulas are great for some things. The flaw here is that this formula does not take the person into account. How healthy are you otherwise? Do you eat well? Do you have other underlying conditions? Do you have other risk factors? Are you getting plenty of Vitamin D? (They are doing a study on Vitamin D and aortic Stenosis- wish I had the link to the one they already completed- maybe I'll come back and post it)
I wouldn't go by the formula. Go by how you feel. Go by your symptoms and be honest to yourself about those symptoms. Go with your gut. And by all means--listen to the others-- ask them "if it was you, would you wait?" and look see see if you get a truthful answer.

 

[skeptic49]

formulas are great for some things. The flaw here is that this formula does not take the person into account. How healthy are you otherwise? Do you eat well? Do you have other underlying conditions? Do you have other risk factors? Are you getting plenty of Vitamin D? (They are doing a study on Vitamin D and aortic Stenosis- wish I had the link to the one they already completed- maybe I'll come back and post it)
I wouldn't go by the formula. Go by how you feel. Go by your symptoms and be honest to yourself about those symptoms. Go with your gut. And by all means--listen to the others-- ask them "if it was you, would you wait?" and look see see if you get a truthful answer.

Good advice, Samantha!

Jim

 

[cbdheartman]

Annual Risk

Annual Risk

When Dr. Cameron went through the risk of rupture or dissection, he said it is an annual risk. This means that every year the risk is the same so it would stay 4% each year not mean a 40% chance over 10 years. The other thing to ask a surgeon is how many people he has told can wait things out have ended up dissecting. I imagine you will find that the surgeon will have a pretty high rate of people being able to wait it out until the aneurysm gets better. I am don't recommend waiting things out; I certainly didn't. I am just throwing that out there.

 

[Equusz]

That's weird, because Dr. Coady, the author of the Yale study cited in this article, emailed me back and told me the risk would be 40% over 10 years.

I'm not a statistician so I can't determine if having a 4% chance of rupture each year means the same as having a 40% chance overall. They may be 2 ways of viewing the same thing. Maybe 40% over 10 years is really very low, like 4% over one year is.

I did email the head of cardiothoracic surgery at Yale, Dr. Elesteriades, who wrote another article on when to operate and cited the low annual risk; I'm still waiting for him to get back to me.

I'd also like to know if the ones who ruptured were treating their BP, etc.

I think there ARE advantages to waiting. Newer technology, the chance of artificial valves that don't require blood thinners, or tissue valves that last 25 years; these things are all around the corner. If I can be convinced that my chance of dissection/rupture is lower than surgery, it's worth waiting for the latest and greatest. The trick is not to wait too long and end up in the closest butcher shop with whoever's on call that day...

 

[cbdheartman]

That is weird. My guess is that your risk of surgery, done at the right place, is less than the risk of dissection/rupture right now. For instance, I was told that my risk of surgery at Hopkins was under 1%. My risk of rupture at nearly 5.0 cm was only 2-4% a year. (I think it was about 3%.) So why wasn't surgery recommended? Because Dr. Cameron was worried about ringing the bell on future surgeries if I did a tissue valve. When it became very probable (after he viewed my echo) that my valve could be spared, he became more equivocal on surgery and his threshold moved down. But if the question is surgical risk, my guess, not knowing your circumstances, is that it is less than your paper risk of rupture/dissection.

For instance, just take a look at these astounding numbers on Marfan patients with aortic root replacement over 30 years at Hopkins:

There were no operative deaths or 30-day mortalities among the 327 patients who had elective repair (Table 2). Forty-five patients underwent urgent or emergent surgery (within 7 days after surgical consultation); there were 2 deaths (4.4%) within 30 days in this group. Both patients who died arrived in the operating room moribund as a result of aortic rupture and pericardial tamponade and both died in the operating room. Of the 45 patients who had urgent or emergent repair, 35 had an acute or chronic dissection of the ascending aorta. The remaining 10 patients had impending rupture or low cardiac output because of severe left ventricular dysfunction.

Think about that in 30 years covered by this study, Hopkins did 372 aortic root replacements on Marfan patients and only 2 died (and they were dead when they got to the table). That is mind-boggling to me. My guess is that Marfan patients also present more difficulties than someone with regular BAV and the attendant connective tissue issues.

 

[Equusz]

Yeah, impressive numbers alright. Will just have to see what the experts at Stanford say about my need for surgery or ability to wait for awhile, until/unless it starts moving from 4.5cm.