RF33 IS THE DIAMETER OF THE AORTA A SAFE PARAMETER FOR CARDIAC SURGERY INDICATION IN AORTIC ANEURYSMS?

Background and Aim: Acute aortic dissection is a life-threatening condition and its prevention is based on elective surgery on patients with known risk factors (connective tissue disorders or chronic degenerative expansive aneurysm). International guidelines suggest elective prophylactic surgery at a diameter of 55 mm in non-syndromic patients. The aim of our study was to verify if current guidelines for elective surgery are effectively reliable in order to prevent acute aortic syndrome. Materials and methods: From April 2005 to March 2018, at the Cardiac Surgery Division of the Tor Vergata University of Rome, 326-patients underwent emergency cardiac surgery for type A acute aortic dissection. The whole series was based on the all-camers cohort. The diameter of the dissected aorta, including the true and false lumen, was evalueted preoperatively by CT scan and intraoperatively by means transesophageal echocardiographic examination. Results: This analysis has documented an average diameter of 54 ± 9 mm of dissected ascending aorta. In particular the 50th and 75th percentiles of patients was 53 mm and 60 mm, respectively. In 65% of patients the diameter of the dissected aorta was ≤ 55 mm. Conclusions: Since the dissected aorta is necessary bigger than the native vessel, the international criteria for elective surgery seem to be inadequate to prevent acute aortic syndrome in a large portion of non-syndromic patients with normal or event dilated proximal aorta. Other factor beside aortic diameter should be identified to improve the efficacy of patients’ selection for elective surgery. © 2018 Italian Federation of Cardiology - I.F.C. All rights reserved.