Grego Susanna, Pozzoli Alberto, Torre Tiziano, Leo Laura Anna, Muretti Mirko, Toto Francesca, Theologou Thomas, Ferrari Enrico, Demertzis Stefanos
Rare Cardiovascular Disease Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland.
Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland.
Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6). doi: 10.1093/icvts/ivaf125.
Acute aortic dissection (AAD) commonly occurs with a dilation of the ascending aorta at diameters under the threshold of surgical indication. Aortic diameter/height index (AHI) has been proposed for risk stratification and more accurate prophylactic surgery.
From January 2001 to November 2023, all patients operated on for AAD at our Institute were prospectively collected and retrospectively analysed, calculating the AHI. A Control Group without aortic pathology was stratified for the same risk index, and a modelling risk analysis for aortic dissection was also performed.
A group of 210 patients was operated during the study period, of whom 168 (80%) had a prevalent post-junctional aortic dilation with a mean aortic diameter at the time of diagnosis of 5.1 ± 0.7 cm. In 53/210 (25%), the aortic diameter was > 5.5 cm. According to AHI, 19/210 patients (9%) were low-risk, 142/210 (67.6%) moderate, 45/210 (21.3%) high and 4/210 (2%) severe risk. In the AHI probability density function, the peak for dissection was 2.93 cm/m for males and 3.05 for females. Control were 6343 patients (3.2% at moderate risk) with AHI of 2.01 cm/m. After simulating the dissecting process, 215 (3.3%) had AHI ≥ 2.9 cm/m.
The measurement of the aortic diameter to height index in patients with acute aortic dissection revealed a significant prevalence of individuals presenting a moderate risk for acute aortic events. Regardless of absolute aortic diameter values, patients with AHI exceeding 2.9 cm/m should be referred to an aortic centre for multidisciplinary risk assessment.
急性主动脉夹层（AAD）通常发生在升主动脉直径扩张但未达到手术指征阈值的情况下。主动脉直径/身高指数（AHI）已被提出用于风险分层和更准确的预防性手术。
收集并回顾性分析2001年1月至2023年11月在我院接受AAD手术的所有患者，计算AHI。对无主动脉病变的对照组进行相同风险指数分层，并对主动脉夹层进行建模风险分析。
研究期间有210例患者接受手术，其中168例（80%）以交界后主动脉扩张为主，诊断时平均主动脉直径为5.1±0.7cm。在210例中的53例（25%）中，主动脉直径>5.5cm。根据AHI，210例患者中有19例（9%）为低风险，142例（67.6%）为中度风险，45例（21.3%）为高风险，4例（2%）为严重风险。在AHI概率密度函数中，男性夹层的峰值为2.93cm/m，女性为3.05cm/m。对照组为6343例患者（中度风险为3.2%），AHI为2.01cm/m。模拟夹层过程后，215例（3.3%）的AHI≥2.9cm/m。
对急性主动脉夹层患者进行主动脉直径与身高指数测量发现，有相当一部分个体存在急性主动脉事件的中度风险。无论主动脉绝对直径值如何，AHI超过2.9cm/m的患者应转诊至主动脉中心进行多学科风险评估。
