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Pisano et al. Vessel Plus 2020;4:33 Vessel Plus
DOI: 10.20517/2574-1209.2020.21

Review Open Access

Risk of aortic dissection in patients with ascending
aorta aneurysm: a new biological, morphological,

and biomechanical network behind the aortic
diameter

Calogera Pisano *, Carmela Rita Balistreri *, Paolo Nardi , Claudia Altieri , Fabio Bertoldo , Dario Buioni ,
1
1
2,
1,
1
1
Maria Sabrina Ferrante , Laura Asta , Daniele Trombetti , Giovanni Ruvolo 1
1
1
1
1 Department of Cardiac Surgery, Tor Vergata University Hospital, Rome 00133, Italy.
2 Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo 90134, Italy.
*These authors contributed equally as first author.
Correspondence to: Prof. Calogera Pisano, Department of Cardiac Surgery, Tor Vergata University Hospital, Viale Oxford 81,
Rome 00133, Italy. E-mail: lindapisano82@gmail.com
How to cite this article: Pisano C, Balistreri CR, Nardi P, Altieri C, Bertoldo F, Buioni D, Ferrante MS, Asta L, Trombetti D, Ruvolo G.
Risk of aortic dissection in patients with ascending aorta aneurysm: a new biological, morphological, and biomechanical network
behind the aortic diameter. Vessel Plus 2020;4:33. http://dx.doi.org/10.20517/2574-1209.2020.21
Received: First Decision: Revised: Accepted: Published: x Received: 31 May 2020 First Decision: 3 Aug 2020 Revised: 22 Aug 2020 Accepted: 10 Sep 2020 Published: 29 Oct 2020
Science Editor: Copy Editor: Production Editor: Jing Yu Academic Editor: Cristiano Spadaccio Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Thoracic aortic aneurysm represents a deadly condition, particularly when it evolves into rupture and dissection.
Proper surgical timing is the key to positively influencing the survival of patients with this pathology. According
to the most recent guidelines, ascending aorta size ≥ 55 mm and a rate of growth ≥ 0.5 cm per year are the
most important factors for surgical indication. Nevertheless, a lot of evidence show that aortic ruptures and
dissections might occur also in small size ascending aorta. In this review, we sought to analyze a new biological
and morphological network behind the aortic diameter that need to be considered in order to identify the portion
of patients with thoracic aortic aneurysm who are at increased risk of aortic complications, despite current aortic
guidelines not advising surgical intervention in this group.

Keywords: Ascending aorta aneurysm; ascending aorta size; aortic dissection; genetic risk factors; morphological
aspects; surgical indication for aortic repair

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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and indicate if changes were made.

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