Indications for prophylactic intervention for thoracic aortic aneurysm
| Aneurysm location and associated conditions | ACC/AHA 20102 | ESC 20141 | Our recommendation |
|---|---|---|---|
| Ascending aorta No associated conditions | ≥ 5.5 cm (I-C)a ≥ 0.5 cm/year growth (I-C) | ≥ 5.5 cm (I-C), lower if small stature, rapid progression, aortic regurgitation (AR), pregnancy, patient preference (IIa-C) | ≥ 5.5 cm π r2/H > 10 |
| Aortic valve surgery planned | > 4.5 cm (I-C) | > 4.5 cm | > 4.5 cm |
| Marfan syndrome | 4.0–5.0 cm (I-C) π r2/H > 10 (IIa-C) | ≥ 5.0 cm (I-C) > 4.5 cm with risk factors or family history (IIa-C) ≥ 0.3 cm/year growth, severe AR, pregnancy desired (IIa-C) | > 4.5 cm π r2/H > 10 |
| Bicuspid aortic valve | ≥ 4.0–5.0 cm (I-C) π r2/H > 10 (IIa-C) | ≥ 5.5 cm without risk factors (I-C) ≥ 5.0 cm with risk factors, family history, hypertension, aortic coarctation (I-C) ≥ 4.5 cm if AVR planned (I-C) ≥ 0.3 cm/year growth (IIa-C) | ≥ 5.0 cm without risk factors ≥ 4.5 cm with risk factors π r2/H > 10 |
| Turner syndrome | 4.0–5.0 cm (I-C) π r2/H > 10 (IIa-C) | Indexed aortic diameter ≥ 27.5 mm/m2 | ≥ 27.5 mm/m2 π r2/H > 10 |
| Loeys-Dietz syndrome (apply to TGFBR1 or TGFBR2 mutation) | ≥ 4.2 cm (TEE) (IIa-C) ≥ 4.4–4.6 cm (CTA/MRA) (IIa-C) | ≥ 5.0 cm (I-C) ≥ 4.5 cm with risk factors (IIa-C) | ≥ 4.5 cm π r2/H > 10 |
| Ehlers-Danlos syndrome | 4.0–5.0 cm (I-C) π r2/H > 10 (IIa-C) | No specific threshold recommended | ≥ 4.5 cm π r2/H > 10 |
| Familial TAA | 4.0–5.0 cm (I-C) π r2/H > 10 (IIa-C) | No specific threshold recommended | ≥ 4.5 cm π r2/H > 10 |
| Aortic arch None | ≥ 5.5 cm (IIa-B) | ≥ 5.5 cm (IIa-C) Consider if having ascending or descending TAA surgery (IIa-C) | ≥ 5.5 cm |
| Descending aorta Stent graft | ≥ 5.5 cm (I-B) | ≥ 5.5 cm (IIa-C) | ≥ 5.5 cm |
| Surgery | ≥ 6.0 cm (I-C) (include high risk, thoracoabdominal) | ≥ 6.0 cm (IIa-C) | ≥ 6.0 cm |
| Surgery with degenerative, traumatic or saccular TAA, or postoperative pseudo-aneurysm | ≥ 5.5 cm (I-B) | No specific threshold recommended | ≥ 5.5 cm |
| Surgery with connective tissue disorder like Marfan or Loeys-Dietz syndrome | Lower threshold than > 6 cm (I-C) | Lower threshold than > 6 cm | ≥ 5.5 cm |
↵a Class of recommendation (scale of I to III) and level of evidence (scale of A to C).
ACC = American College of Cardiology; AHA = American Heart Association; AVR = aortic valve surgery; CTA = computed tomographic angiography; ESC = European Society of Cardiology; MRA = magnetic resonance angiography π r2/H = maximal cross-sectional area of TAA divided by height; TAA = thoracic aortic aneurysm