What are the guidelines for surgery in thoracic aortic aneurysm (TAA)?

Updated: Apr 02, 2021
  • Author: Elaine Tseng, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

As one may imagine, the quality of data and level of evidence supporting these recommendations widely vary. Given these variations and the importance of the subject matter, in 2010, a joint task force spearheaded by the American College of Cardiology Foundation and the American Heart Association, and composed of members of many professional societies specializing in treatment of diseases of the thoracic aorta, produced an Executive Summary detailing guidelines for diagnosis and management of this disease, which will be annually updated. [45]

Indications for surgical treatment may be summarized as follows:

  • Aortic size - Ascending aortic diameter ≥5.5 cm or twice the diameter of the normal contiguous aorta; descending aortic diameter ≥6.5 cm; subtract 0.5 cm from the cutoff measurement in the presence of Marfan syndrome, family history of aneurysm or connective tissue disorder, bicuspid aortic valve, aortic stenosis, dissection, patient undergoing another cardiac operation; growth rate ≥1 cm/year
  • Symptomatic aneurysm
  • Traumatic aortic rupture
  • Acute type B aortic dissection with associated rupture, leak, distal ischemia
  • Pseudoaneurysm
  • Large saccular aneurysm
  • Mycotic aneurysm
  • Aortic coarctation
  • Bronchial compression by aneurysm
  • Aortobronchial or aortoesophageal fistula

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