title: Acute Type A Aortic Dissection: Beyond the Diameter.
abstract: Aortic dissection is a life-threatening condition in which early diagnosis, treatment and close follow up are critical for survival. Between 60% and 70% of patients with acute aortic dissection are affected at the ascending aorta, classified as Stanford type A (TAD). Preventive surgery of the aorta in asymptomatic patients on the basis of aortic size alone remains controversial among patient populations without known risk factors for aortic dissection. In fact, many dissection patients do not appear to have markedly dilated aortas at the time of presentation. In contrast, previous studies have indicated that the incidence of aortic dissection did not decrease, regardless of elective aortic replacement therapy. An increased aortic size as a follow up parameter is not sufficient to predict aortic dissection and rupture. Here, published evidence is reported regarding the limited role of aortic size in the genesis of TAD. Currently, a need exists to develop new markers to prevent aortic complications, especially in patients with sporadic ascending aneurysms (S-TAAs). It is important to emphasize this interesting aspect to the scientific cardiothoracic surgery forum in an attempt to improve guidelines for this disease.
authors.affiliation: Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Sicily. Electronic correspondence: bacalipi@libero.it.
authors.forename: Calogera
authors.initials: C
authors.lastname: Pisano
authors.affiliation: Department of Pathobiology and Medical and Forensic Biotechnologies, University of Palermo, Sicily.
authors.forename: Carmela
authors.initials: C
authors.lastname: Rita Balistreri
authors.affiliation: Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Sicily.
authors.forename: Oreste
authors.initials: O
authors.lastname: Fabio Triolo
authors.affiliation: Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Sicily.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Argano
authors.affiliation: Department of Cardiac Surgery, University of Rome 'Tor Vergata', Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruvolo
mesh_terms: D000784:Aortic Dissection / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D004108:Dilatation, Pathologic; D006801:Humans; D012307:Risk Factors; D012422:Rupture, Spontaneous