Recommendations for Surgery for Sporadic Aneurysms of the Aortic Root and Ascending Aorta
Referenced studies that support the recommendations are summarized in the Online Data Supplement.
| COR | LOE | Recommendations |
|---|---|---|
| 1 | C-LD | 1. In patients with aneurysms of the aortic root and ascending aorta who have symptoms attributable to the aneurysm, surgery is indicated.1,2 |
| 1 | B-NR | 2. In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have a maximum diameter of ≥5.5 cm, surgery is indicated.3–9 |
| 1 | C-LD | 3. In patients with an aneurysm of the aortic root or ascending aorta of <5.5 cm, whose growth rate confirmed by tomographic imaging is ≥0.3 cm/y in 2 consecutive years, or ≥0.5 cm in 1 year, surgery is indicated.10–13 |
| 2a | B-NR | 4. In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have a maximum diameter of ≥5.0 cm, surgery is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.14–17 |
| 2a | B-NR | 5. In patients undergoing repair or replacement of a tricuspid aortic valve who have a concomitant aneurysm of the ascending aorta with a maximum diameter of ≥4.5 cm, ascending aortic replacement is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.18–21 In patients undergoing repair or replacement of a tricuspid aortic valve who have a concomitant aneurysm of the ascending aorta with a maximum diameter of ≥5.0 cm, ascending aortic replacement is reasonable.18–21 In patients undergoing cardiac surgery for indications other than aortic valve repair or replacement who have a concomitant aneurysm of ascending aorta with a maximum diameter of ≥5.0 cm, ascending aortic replacement may be reasonable.18 |
| 2a | B-NR | |
| 2b | C-LD | |
| 2a | C-LD | 6. In patients with a height >1 standard deviation above or below the mean who have an asymptomatic aneurysm of the aortic root or ascending aorta and a maximal cross-sectional aortic area/height ratio of ≥10 cm2/m, surgery is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.14,15,22 |
| 2b | C-LD | 7. In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have either an ASI of ≥3.08 cm/m2 or AHI of ≥3.21 cm/m, surgery may be reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.23 |