Are dilated ascending aortas of Chinese patients more likely to dissect?

BACKGROUND

Ascending aortic aneurysm is a disease requiring surgical intervention. However, the timing of operation is still controversial. The purpose of this study is to compare the ascending aortic diameter and postoperative outcomes in hospital between patients with simple ascending aortic dissection and patients with simple ascending aortic dilation in China, and to investigate the accuracy of the timing of operation determined by ascending aortic diameter alone.

METHODS

We reviewed the data from 2,520 hospitalized patients of aortic aneurysm and aortic dissection who underwent surgical treatment from January 2010 to June 2017 in our hospital. A total of 139 simple ascending aortic dissection and simple ascending aortic aneurysm hospitalized patients excluding Marfan syndrome and heart valve diseases etc. (56 in the aortic dilatation group and 83 in the aortic dissection group) were enrolled. The t-test and univariable analysis were used to compare the differences between two groups.

RESULTS

For the aortic diameter, the group of aneurysm has greater ascending aortic diameter and the index of ascending aortic diameter compared with the group of dissection (P<0.001, P<0.001). For male patients, the result is the same (P<0.001, P<0.001). But for female patients, there was no significant statistical significance between the two groups (P=0.631, P=0.288). For the postoperative outcomes, the dissection group had higher mortality, incidence of tracheotomy and postoperative re-exploration for hemorrhage (P=0.040, P=0.011, P=0.028).

CONCLUSIONS

The majority of patients with simple ascending aortic dissection present with aortic diameters <5.5 cm and this is not consistent with the current operation indications of aortic aneurysm. It is far from enough to predict aortic dissection with aortic diameter alone. More indicators are needed to do this.