Kitada Yuichiro, Okamura Homare, Yamauchi Taketo, Nishi Satoshi, Arakawa Mamoru, Kimura Naoyuki, Kawahito Koji, Yamaguchi Atsushi
Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
J Thorac Cardiovasc Surg. 2025 Feb;169(2):542-551.e3. doi: 10.1016/j.jtcvs.2024.01.030. Epub 2024 Jan 26.
The predissection aortic diameter is the best reference for determining the size of the frozen elephant trunk in aortic dissection. We aimed to develop a new prediction method to estimate the predissection diameter of proximal descending aorta. Furthermore, we evaluated the accuracy of the estimated predissection proximal descending aortic diameters calculated using 3 prediction methods.
A total of 39 patients with acute type A aortic dissection who underwent predissection computed tomography were included in derivation sets. We measured the aortic dimensions at 3 levels of the proximal descending aorta: 5, 10, and 15 cm from zone 2. We developed a new prediction method-postdissection aortic diameter divided by 1.13 (AoD)-and estimated the predissection aortic diameter using the new and previously proposed methods by Rylski (AoD) and Yamauchi (Equation). Furthermore, we validated the new prediction method using a validation dataset with 24 patients.
The rate of bias ≤2 mm was significantly greater with Equation and AoD than with AoD in the derivation group at each level of the proximal descending aorta (P < .001). In the validation group, the rate of bias ≤2 mm was significantly greater with Equation and AoD than with AoD at 10 cm and 15 cm from zone 2 (10 cm: P = .014, 15 cm: P < .001).
These results suggest that the new prediction method can be used as a simple and accurate estimation method for the predissection aortic diameter at the proximal descending aorta.
解剖前主动脉直径是确定主动脉夹层中冰冻象鼻支架尺寸的最佳参考指标。我们旨在开发一种新的预测方法来估计降主动脉近端的解剖前直径。此外，我们评估了使用三种预测方法计算出的解剖前降主动脉近端直径估计值的准确性。
共有39例接受了解剖前计算机断层扫描的急性A型主动脉夹层患者被纳入推导数据集。我们在降主动脉近端的三个水平（距第二区5、10和15厘米处）测量了主动脉尺寸。我们开发了一种新的预测方法——解剖后主动脉直径除以1.13（AoD）——并使用新方法以及Rylski（AoD）和Yamauchi（公式）先前提出的方法来估计解剖前主动脉直径。此外，我们使用包含24例患者的验证数据集对新的预测方法进行了验证。
在降主动脉近端的每个水平上，推导组中公式法和AoD法的偏差≤2毫米的比例显著高于AoD法（P <.001）。在验证组中，在距第二区10厘米和15厘米处，公式法和AoD法的偏差≤2毫米的比例显著高于AoD法（10厘米：P =.014，15厘米：P <.001）。
这些结果表明，新的预测方法可作为一种简单且准确的估计降主动脉近端解剖前主动脉直径的方法。
