Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
Perfusion. 2020 Mar;35(2):131-137. doi: 10.1177/0267659119858848. Epub 2019 Jul 31.
Aim of this study was to evaluate ascending aorta and aortic root dimension at acute type A dissection (acute aortic dissection) and to identify demographics elements being allied to the acute event.
In a period between 2009 and 2017, 225 (n = 71, 32% female, mean age = 63 ± 12 years) patients eligible for analysis of ascending aorta and 223 (n = 70, 31% female, mean age = 63 ± 13 years) of aortic root were included in this study. Aortic diameter was assessed in preoperative computed tomography scan. The predissection diameters were modeled from the diameters obtained at diagnosis, assuming 30% augmentation of the diameter at acute event.
The mean diameter of the ascending aorta at dissection was 46 ± 8 mm and the modeled diameter was 32.3 ± 5.7 mm. The diameter of the aortic root at dissection was 42 ± 8 mm and modeled diameter was 29.5 ± 5.6 mm. In multivariate analysis, female gender (p = 0.026) and history of cerebrovascular event (p = 0.001) were associated with acute aortic dissection in small aortic root. Patient age (p < 0.001) and history of inguinal hernia (p = 0.001) in ascending aorta <55 mm correlated with acute aortic dissection.
Modeling indicates that more than 90% of patients had aortic root and ascending aorta diameter <45 mm. It seems that the aortic diameter expansion over the 55 mm in development of acute aortic dissection is overestimated. Parameters other than aortic size were identified, which may be considered when patients at high risk for dissection were identified.
本研究旨在评估急性 A 型夹层（急性主动脉夹层）升主动脉和主动脉根部的尺寸，并确定与急性事件相关的人口统计学因素。
在 2009 年至 2017 年期间，共有 225 名（n=71，32%为女性，平均年龄=63±12 岁）符合升主动脉分析条件和 223 名（n=70，31%为女性，平均年龄=63±13 岁）符合主动脉根部分析条件的患者纳入本研究。术前计算机断层扫描评估主动脉直径。假设在急性事件时直径增加 30%，从诊断时获得的直径来推断夹层前的直径。
夹层时升主动脉的平均直径为 46±8mm，模型直径为 32.3±5.7mm。夹层时主动脉根部的直径为 42±8mm，模型直径为 29.5±5.6mm。多变量分析显示，女性（p=0.026）和脑血管事件史（p=0.001）与小主动脉根部的急性主动脉夹层相关。升主动脉<55mm 时患者年龄（p<0.001）和腹股沟疝史（p=0.001）与急性主动脉夹层相关。
建模表明，超过 90%的患者主动脉根部和升主动脉直径<45mm。主动脉夹层发展过程中直径超过 55mm 的扩张似乎被高估了。除了主动脉大小之外，还确定了其他参数，这些参数可用于识别高危夹层患者。
