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Diagnosis and Management of Aortic Disease

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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.

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