Aortic diameter predicts acute type A aortic dissection in patients with Marfan syndrome but not in patients without Marfan syndrome

Objectives: Among the parameters for surveillance of patients at risk of acute type A aortic dissection, the aortic size has been considered a cardinal factor. Preventive surgery of the aorta in asymptomatic patients on the basis of size alone is still controversial in patient populations lacking other risk factors for aortic dissection. The aim of the present study was to assess the value of the aortic diameter as a current criterion for elective aortic surgery to prevent the development of aortic dissection in patients without and with Marfan syndrome (MFS). Methods: We reviewed the data from patients diagnosed with acute type A aortic dissection from December 1994 to March 2009 at our institute. A total of 237 patients who presented with acute type A aortic dissection were enrolled, of whom 31 were diagnosed with MFS. Results: The maximal ascending aorta size was 46.7 mm (range, 42.9-51.6) in non-MFS patients and 58.5 mm (range, 43.8-64.9) in MFS patients (P <.001). Two thirds (74%) of the MFS patients had a maximal aortic root size of ≥45 mm. However, 87% of the 206 non-MFS patients had an aortic diameter <55 mm. Non-MFS patients presenting with an aortic size <55 mm developed aortic dissection at a younger age and had a higher body mass index than those with an aortic size ≥55 mm. Conclusions: Type A aortic dissection occurs in smaller aortas in non-MFS patients compared with those with MFS.