Thoracic aortic aneurysm surgery
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Thoracic aortic aneurysm Microchapters |
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Differentiating Thoracic Aortic Aneurysm from other Diseases |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Thoracic aortic aneurysm surgery On the Web |
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Directions to Hospitals Treating Thoracic aortic aneurysm surgery |
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Risk calculators and risk factors for Thoracic aortic aneurysm surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
ACC/ AHA Guidelines - Recommendation for Asymptomatic patients with Ascending aortic aneurysm (DO NOT EDIT)
| Class I |
| 1. Asymptomatic patients with degenerative thoracic aneurysm, chronic aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, mycotic aneurysm, or pseudoaneurysm, who are otherwise suitable candidates and for whom the ascending aorta or aortic sinus diameter is 5.5 cm or greater should be evaluated for surgical repair (Level of Evidence: A) |
| 2. Patients with Marfan syndrome or other genetically mediated disorders (vascular Ehlers-Danlos syndrome, Turner syndrome, bicuspid aortic valve, or familial thoracic aortic aneurysm and dissection) should undergo elective operation at smaller diameters (4.0 to 5.0 cm depending on the condition; to avoid acute dissection or rupture (Level of Evidence: C) |
| 3.Patients with a growth rate of more than 0.5 cm/y in an aorta that is less than 5.5 cm in diameter should be considered for operation. (Level of Evidence: C) |
| 4.Patients undergoing aortic valve repair or replacement and who have an ascending aorta or aortic root of greater than 4.5 cm should be considered for concomitant repair of the aortic root or replacement of the ascending aorta (Level of Evidence:C) |
| Class IIa |
| 1.Elective aortic replacement is reasonable for patients with Marfan syndrome, other genetic diseases, or bicuspid aortic valves, when the ratio of maximal ascending or aortic root area (πr2) in cm2 divided by the patient's height in meters exceeds 10 (Level of Evidence:C) |
| 2.It is reasonable for patients with Loeys-Dietz syndrome or a confirmed TGFBR1 or TGFBR2 mutation to undergo aortic repair when the aortic diameter reaches 4.2 cm or greater by transesophageal echocardiogram (internal diameter) or 4.4 to 4.6 cm or greater by computed tomographic imaging and/or magnetic resonance imaging (external diameter. (Level of Evidence:C) |
ACC/ AHA Guidelines - Recommendations for Symptomatic patients with Thoracic aortic aneurysms (DO NOT EDIT)
| Class I |
| 1. Patients with symptoms suggestive of expansion of a thoracic aneurysm should be evaluated for prompt surgical intervention unless life expectancy from comorbid conditions is limited or quality of life is substantially impaired.(Level of Evidence: A) |
ACC/ AHA Guidelines - Recommendation for Open surgery for ascending aortic aneurysm (DO NOT EDIT)
| Class I |
| 1.Separate valve and ascending aortic replacement are recommended in patients without significant aortic root dilatation, in elderly patients, or in young patients with minimal dilatation who have aortic valve disease (Level of Evidence: C) |
| 2.Patients with Marfan, Loeys-Dietz, and Ehlers-Danlos syndromes and other patients with dilatation of the aortic root and sinuses of Valsalva should undergo excision of the sinuses in combination with a modified David reimplantation operation if technically feasible or, if not, root replacement with valved graft conduit. (Level of Evidence: B) |