38
Treatment
Table 13. Surgical Thresholds for Prophylactic Aortic
Root and Ascending Aortic Replacement in
Nonsyndromic Heritable Thoracic Aortic Disease
Based on the Genetic Variant and Additional Risk
Factors for Aortic Dissection
COR* LOE*
Genetic
Variant Risk Factors
Aortic
Diameter (cm)
2a C-LD ACTA2 No ≥4.5
2b C-EO ACTA2
Yes
†
≥4.2
2b C-LD PRKG1 No ≥4.2
2b C-EO PRKG1
Yes
†
≥4.0
†
* Patient has risk factors for aortic dissection (family history of type A aortic dissection with
minimal aortic enlargement, aortic growth rate ≥0.3 cm/y) or significant valve disease
requiring surgery.
†
Earlier surgery may be considered in patients with a family history of type A aortic dissection
in the setting of no or minimal aortic dilation, aortic growth rate ≥0.3 cm/y, or at the
patient's request.
