Prophylactic aortic surgery at a 50 mm threshold is not supported by sufficient evidence, as the operative mortality risk of at least 2% outweighs the 1.4% combined annual risk of adverse aortic events.
Should the threshold for prophylactic aortic surgery be lowered to 50 mm based on ascending aortic diameter?
This editorial argues against lowering the threshold for prophylactic aortic surgery to 50 mm, citing insufficient evidence.
We read with interest the publication by Wu et al. 1 reporting the annual rate of aortic dissection, rupture, and death as a function of maximum ascending aortic diameter.In patients with diameters between 45 and 50 mm, 50 and 55 mm, and 55 and 60 mm, the risk of adverse aortic events and death (AAE) is 0.3%, 1.4%, and 2%, respectively, and the risk of aortic death is 0.1%, 0.8%, and 1.3%.The authors' conclusion is that aortic risk increases significantly above 50 mm and that, consequently, this diameter should be the new threshold for prophylactic aortic surgery.There are three main points which, in our opinion, should lead us to reconsider these results and therefore this position:
“Our study provides some of the best evidence to date that observation, coupled with excellent BP control and activity restrictions, is a viable and safe strategy for nonsyndromic patients with thoracic aortic aneurysms less than 5.5 cm.”
Milleron et al. (Sat,) conducted a letter in Ascending thoracic aortic aneurysm. Prophylactic aortic surgery vs. Conservative management (unoperated) was evaluated. Prophylactic aortic surgery at a 50 mm threshold is not supported by sufficient evidence, as the operative mortality risk of at least 2% outweighs the 1.4% combined annual risk of adverse aortic events.