Indications for aortic replacement

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Presentation transcript:

Indications for aortic replacement John A. Elefteriades, MD The Journal of Thoracic and Cardiovascular Surgery Volume 140, Issue 6, Pages S5-S9 (December 2010) DOI: 10.1016/j.jtcvs.2010.10.001 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Thoracic aortic aneurysm, although virulent, is an indolent disease. The aorta grows slowly (∼1 cm per decade), as indicated in this schematic. The descending aorta generally grows faster than the ascending aorta. The Journal of Thoracic and Cardiovascular Surgery 2010 140, S5-S9DOI: (10.1016/j.jtcvs.2010.10.001) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Five-year hazard estimates are illustrated for patients as a function of initial aneurysm size (P < .0045). The Journal of Thoracic and Cardiovascular Surgery 2010 140, S5-S9DOI: (10.1016/j.jtcvs.2010.10.001) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Lifetime increase in risk of rupture or dissection as the aorta enlarges to specific dimensions. Note the abrupt hinge-point at 6 cm for the ascending aorta (A) and 7 cm for the descending aorta (B). The Journal of Thoracic and Cardiovascular Surgery 2010 140, S5-S9DOI: (10.1016/j.jtcvs.2010.10.001) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Research has shown that the likelihood of rupture, dissection, or death increases sharply for aneurysms that reach 6 cm or more. (The rates indicated for “Rupture or Dissection” and for “Rupture, Dissection, or Death” are lower than the sum of the rates in individual categories because patients with multiple complications were counted only once in the combined categories.) On the basis of this information, investigators have determined that many patients with aneurysms in the ascending aorta require surgery when the artery reaches 5.5 cm. The Journal of Thoracic and Cardiovascular Surgery 2010 140, S5-S9DOI: (10.1016/j.jtcvs.2010.10.001) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Intervention recommendations that incorporate size criteria developed as an integral component for managing patients with thoracic aortic aneurysm. The Journal of Thoracic and Cardiovascular Surgery 2010 140, S5-S9DOI: (10.1016/j.jtcvs.2010.10.001) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Distensibility values in normal aortas and aortic aneurysms of different diameters. Distensibility of ascending aortic aneurysms decreases rapidly as diameter increases, to very low values at dimensions greater than 6 cm. The Journal of Thoracic and Cardiovascular Surgery 2010 140, S5-S9DOI: (10.1016/j.jtcvs.2010.10.001) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions