Predictor Analysis for Acute Type A Aortic Dissection in Small Aortic Diameters

Background: The risk for acute aortic dissection (AAD) increases with ascending aortic diameter especially above a cut-off of 60 mm. Therefore, ESC/EACTS guidelines recommend prophylactic replacement of the ascending aorta from a diameter of 55 mm. However, 60% of AAD occur at small aortic diameters (defined as maximum diameter of ascending aorta / aortic root < 55 mm). To identify patients at risk, we sought to evaluate predictors for AAD in patients with aortic diameters < 55 mm.

Method: Between 2005 and 2021 a total of 3,903 consecutive patients underwent surgical repair for AAD in 18 European centers and were imputed retrospectively into the European registry of type A aortic dissection (ERTAAD). Data on ascending aorta/aortic root diameter was available in 2,266 patients. Predictors for AAD in small aortic diameters were identified using multivariable logistic regression analysis. The following covariates were examined: age, weight, height, gender, Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome, Turner syndrome, bicuspid aortic valve, family history of dissection, prior cardiac surgery, any prior aortic intervention, diabetes, extracardiac arteriopathy, and hypertension.

Results: Age was 63.1 ± 13.3 years and 1,508 (69.3%) of patients were male. Maximum ascending aorta/aortic root diameter was 51.6 ± 9.8 cm and in 1,588 patients (70.1%), small aortic diameter was present. Logistic regression analysis identified female gender (adjusted OR: = 1.339, 95% CI: 1.060–1.690; p = 0.014) and body size < 180 cm (adjusted OR = 1.315, 95% CI: 1.052–1.643; p = 0.016) as independent predictors for a small aortic diameter at the time of AAD. Bicuspid aortic valve (adjusted OR = 0.212, 95% CI: 0.140–0.322; p < 0.001) and prior cardiac surgery (adjusted OR = 0.551, 95% CI: 0.342–0.888; p = 0.014) were found to be independent predictors for a large aortic diameter at the time of AAD. Neither heritable aortic diseases, nor positive family history or hypertension were associated with AAD at a small aortic diameter.

Conclusion: Our data suggest that women and patients with short stature are at increased risk for AAD despite a small aortic diameter. In these patients, prophylactic aortic surgery may be beneficial in diameters below the guideline cut-off of > 55 mm. To confirm these results, prospective data are urgently needed.

Publication History

Article published online:
28 January 2023