Pisano Calogera, Rita Balistreri Carmela, Fabio Triolo Oreste, Argano Vincenzo, Ruvolo Giovanni
Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Sicily. Electronic correspondence:
Department of Pathobiology and Medical and Forensic Biotechnologies, University of Palermo, Sicily.
J Heart Valve Dis. 2016 Nov;25(6):764-768.
Aortic dissection is a life-threatening condition in which early diagnosis, treatment and close follow up are critical for survival. Between 60% and 70% of patients with acute aortic dissection are affected at the ascending aorta, classified as Stanford type A (TAD). Preventive surgery of the aorta in asymptomatic patients on the basis of aortic size alone remains controversial among patient populations without known risk factors for aortic dissection. In fact, many dissection patients do not appear to have markedly dilated aortas at the time of presentation. In contrast, previous studies have indicated that the incidence of aortic dissection did not decrease, regardless of elective aortic replacement therapy. An increased aortic size as a follow up parameter is not sufficient to predict aortic dissection and rupture. Here, published evidence is reported regarding the limited role of aortic size in the genesis of TAD. Currently, a need exists to develop new markers to prevent aortic complications, especially in patients with sporadic ascending aneurysms (S-TAAs). It is important to emphasize this interesting aspect to the scientific cardiothoracic surgery forum in an attempt to improve guidelines for this disease.
主动脉夹层是一种危及生命的疾病，早期诊断、治疗及密切随访对生存至关重要。60%至70%的急性主动脉夹层患者病变位于升主动脉，归类为斯坦福A型（TAD）。对于无已知主动脉夹层风险因素的患者群体，仅依据主动脉大小对无症状患者进行主动脉预防性手术仍存在争议。事实上，许多夹层患者在就诊时主动脉似乎并无明显扩张。相比之下，既往研究表明，无论采用选择性主动脉置换治疗与否，主动脉夹层的发生率均未降低。主动脉大小增加作为随访参数不足以预测主动脉夹层和破裂。在此，报告已发表的关于主动脉大小在TAD发生中作用有限的证据。目前，需要开发新的标志物以预防主动脉并发症，尤其是散发性升主动脉瘤（S-TAA）患者。向心胸外科科学论坛强调这一有趣的方面很重要，以期改进该疾病的诊疗指南。
