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2 . 2023

Decision-making in thoracic aorta dilatation. State of the art

Abstract

According to recent guidelines, the main criterion for decision-making in aneurysmal thoracic aorta is its diameter. However, it is now well known that not only this parameter is responsible for aortic related events. Many authors confirm the need for searching additional indications for surgical interventions, including anatomical peculiarities revealed by the findings of multislice computed tomography.

At present, the primary emphasis is on analyzing peculiarities of diagnosis of and surgical approaches to thoracic aortic aneurysms, with the treatment of thoracic aortic dilatation (40–49 mm) being mainly out of the scope. Thoracic aortic dilatation requires additional investigations aimed to determine whether conservative or surgical management is adequate. To date, a scarce evidence base determines diversity of researchers’ opinions on this issue.

Keywords:aortic aneurysm; aortic dilatation; thoracic aortic surgery

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflict of interest.

Authors’ contribution. Study conception and design – Kozlov B.N., Panfilov D.S.; draft manuscript preparation – Panfilov D.S.; manuscript revision – Kozlov B.N.

For citation: Kozlov B.N., Panfilov D.S. Decision-making in thoracic aorta dilatation. State of the art. Аngiology and Vascular Surgery. 2023; 29 (2): 157–60. DOI: https://doi.org/10.33029/1027-6661-2023-29-2-157-160 (in Russian)

References

1. Bossone E., Eagle K.A. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nature Reviews Cardiology. 2021; 18 (5): 331–348. DOI: https://doi.org/10.1038/s4156 9-020-00472-6

2. Clinical guidelines. guidelines for the diagnosis and treatment of aortic diseases (2017). Cardiology and cardiovascular surgery. 2018; 11 (1): 7–67. (in Russian)

3. Elefteriades J.A., Farkas E.A. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. Journal of the American College of Cardiology. 2010; 55 (9): 841–857. DOI: https://doi.org/10.1016/j.jacc.2009.08.084

4. Elefteriades J.A., Mukherjee S.K., Mojibian H. Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2020; 76 (2): 201–217. DOI: https://doi.org/10.1016/j.jacc.2020.03.084

5. Haunschild J., Barnard S.J., Misfeld M., et al. Proximal aortic aneurysms: correlation of maximum aortic diameter and aortic wall thickness. European Journal of Cardio-Thoracic Surgery. 2021; 60 (2): 322–330. DOI: https://doi.org/10.1093/ejcts/ezab147

6. Zafar M.A., Li Y., Rizzo J.A., et al. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. Journal of Thoracic and Cardiovascular Surgery. 2018; 155 (5): 1938–1950. DOI: https://doi.org/10.1016/j.jtcvs.2017.10.140

7. Wu J., Zafar M.A., Li Y. Ascending Aortic Length and Risk of Aortic Adverse Events: The Neglected Dimension. Journal of the American College of Cardiology. 2019; 74 (15): 1883–1894. DOI: https://doi.org/10.1016/j.jacc.2019.07.078

8. Krüger T., Oikonomou A., Schibilsky D., et al. Aortic elongation and the risk for dissection: the Tubingen aortic pathoanatomy (TAIPAN) project. European Journal of Cardio-Thoracic Surgery. 2017; 51 (6): 1119–1126. DOI: https://doi.org/10.1093/ejcts/ezx005

9. Ziganshin B.A., Elefteriades J.A. Guilt by association: a paradigm for detection of silent aortic disease. Annals of Cardiothoracic Surgery. 2016; 5 (3): 174–187. DOI: https://doi.org/10.21037/acs.2016.05.13

10. Sun L., Li X., Li Q., et al. Morphological Features of Aortic Arch Predicting the Risk for Acute Type B Aortic Dissection. World Journal of Surgery. 2021; 45 (11): 3458–3466. DOI: https://doi.org/10.1007/s00268-021-06247-5

11. Marrocco-Trischitta M.M., Rylski B., Schofer F., et al. Prevalence of type III arch configuration in patients with type B aortic dissection. European Journal of Cardio-Thoracic Surgery. 2019; 56 (6): 1075–1080. DOI: https://doi.org/10.1093/ejcts/ezz137

12. Houben I.B., Nama N., Moll F.L., et al. Mapping pre-dissection aortic wall abnormalities: a multiparametric assessment. European Journal of Cardio-Thoracic Surgery. 2020; 57 (6): 1061–1067. DOI: https://doi.org/10.1093/ejcts/ezz381

13. Lenivtceva I., Panfilov D., Kopanitsa G., et al. Aortic Risks Prediction Models after Cardiac Surgeries Using Integrated Data. Journal of Personalized Medicine. 2022; 12 (4): 637. DOI: https://doi.org/10.3390/jpm12040637

14. Irtyuga O., Kopanitsa G., Kostareva A., et al. Application of Machine Learning Methods to Analyze Occurrence and Clinical Features of Ascending Aortic Dilatation in Patients with and without Bicuspid Aortic Valve. Journal of Personalized Medicine. 2022; 12 (5): 794. DOI: https://doi.org/10.3390/jpm12050794

Абсолютно понятно, что поиск дополнительных критериев в определении показаний к операции, не исключая важности оценки значения размеров аорты, позитивно отразится на прогнозировании рисков развития аорто-ассоциированных осложнений, а следовательно, будет способствовать корректному отбору пациентов на хирургическое вмешательство без увеличения рисков развития интра- и послеоперационных осложнений и летальности.

Заключение

Одной из задач современной хирургии грудной аорты является оценка необходимости и целесообразности хирургического лечения пациентов с дилатированной аортой. Поиск дополнительных клинико-инструментальных предикторов развития аорто-ассоциированных событий позволит лучше прогнозировать течение патологии и предоставить весомые аргументы и контраргументы относительно возможности и необходимости оперативного лечения больных с дилатированной грудной аортой.

Литература

1. Bossone E., Eagle K.A. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nature Reviews Cardiology. 2021; 18 (5): 331-348. DOI: https://doi.org/10.1038/s4156 9-020-00472-6

2. Клинические рекомендации. Рекомендации по диагностике и лечению заболеваний аорты (2017). Кардиология и сердечно-сосудистая хирургия. 2018; 11 (1): 7-67.

3. Elefteriades J.A., Farkas E.A. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. Journal of the American College of Cardiology. 2010; 55 (9): 841-857. DOI: https://doi.org/10.1016/j.jacc.2009.08.084

4. Elefteriades J.A., Mukherjee S.K., Mojibian H. Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2020; 76 (2): 201-217. DOI: https://doi.org/10.1016/j.jacc.2020.03.084

5. Haunschild J., Barnard S.J., Misfeld M., et al. Proximal aortic aneurysms: correlation of maximum aortic diameter and aortic wall thickness. European Journal of Cardio-Thoracic Surgery. 2021; 60 (2): 322-330. DOI: https://doi.org/10.1093/ejcts/ezab147

6. Zafar M.A., Li Y., Rizzo J.A., et al. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. Journal of Thoracic and Cardiovascular Surgery. 2018; 155 (5): 1938-1950. DOI: https://doi.org/10.1016/j.jtcvs.2017.10.140

7. Wu J., Zafar M.A., Li Y. Ascending Aortic Length and Risk of Aortic Adverse Events: The Neglected Dimension. Journal of the American College of Cardiology. 2019; 74 (15): 1883-1894. DOI: https://doi.org/10.1016/j.jacc.2019.07.078

8. Krüger T., Oikonomou A., Schibilsky D., et al. Aortic elongation and the risk for dissection: the Tubingen aortic pathoanatomy (TAIPAN) project. European Journal of Cardio-Thoracic Surgery. 2017; 51 (6): 1119-1126. DOI: https://doi.org/10.1093/ejcts/ezx005

9. Ziganshin B.A., Elefteriades J.A. Guilt by association: a paradigm for detection of silent aortic disease. Annals of Cardiothoracic Surgery. 2016; 5 (3): 174-187. DOI: https://doi.org/10.21037/acs.2016.05.13

10. Sun L., Li X., Li Q., et al. Morphological Features of Aortic Arch Predicting the Risk for Acute Type B Aortic Dissection. World Journal of Surgery. 2021; 45 (11): 3458-3466. DOI: https://doi.org/10.1007/s00268-021-06247-5

11. Marrocco-Trischitta M.M., Rylski B., Schofer F., et al. Prevalence of type III arch configuration in patients with type B aortic dissection. European Journal of Cardio-Thoracic Surgery. 2019; 56 (6): 1075-1080. DOI: https://doi.org/10.1093/ejcts/ezz137

12. Houben I.B., Nama N., Moll F.L., et al. Mapping pre-dissection aortic wall abnormalities: a multiparametric assessment. European Journal of Cardio-Thoracic Surgery. 2020; 57 (6): 1061-1067. DOI: https://doi.org/10.1093/ejcts/ezz381

13. Lenivtceva I., Panfilov D., Kopanitsa G., et al. Aortic Risks Prediction Models after Cardiac Surgeries Using Integrated Data. Journal of Personalized Medicine. 2022; 12 (4): 637. DOI: https://doi.org/10.3390/jpm12040637

14. Irtyuga O., Kopanitsa G., Kostareva A., et al. Application of Machine Learning Methods to Analyze Occurrence and Clinical Features of Ascending Aortic Dilatation in Patients with and without Bicuspid Aortic Valve. Journal of Personalized Medicine. 2022; 12 (5): 794. DOI: https://doi.org/10.3390/jpm12050794

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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