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Treatment
6.5.1. Surgery for Sporadic Aneurysms of the Aortic Root
and Ascending Aorta
COR LOE
Recommendations
1 C-LD 1. In patients with aneurysms of the aortic root and ascending
aorta who have symptoms attributable to the aneurysm,
surgery is indicated.
1 B-NR 2. In asymptomatic patients with aneurysms of the aortic root or
ascending aorta who have a maximum diameter of ≥5.5 cm,
surgery is indicated.
1 C-LD 3. In patients with an aneurysm of the aortic root or ascending
aorta of <5.5 cm, whose growth rate confirmed by
tomographic imaging is ≥0.3 cm/y in 2 consecutive years, or
≥0.5 cm in 1 year, surgery is indicated.
2a B-NR 4. In asymptomatic patients with aneurysms of the aortic root or
ascending aorta who have a maximum diameter of ≥5.0 cm,
surgery is reasonable when performed by experienced surgeons
in a Multidisciplinary Aortic Team.
2a B-NR 5. In patients undergoing repair or replacement of a tricuspid
aortic valve who have a concomitant aneurysm of the
ascending aorta with a maximum diameter of ≥ 4.5 cm,
ascending aortic replacement is reasonable when performed by
experienced surgeons in a Multidisciplinary Aortic Team
2a B-NR In patients undergoing repair or replacement of a tricuspid
aortic valve who have a concomitant aneurysm of the
ascending aorta with a maximum diameter of ≥5.0 cm,
ascending aortic replacement is reasonable.
2b C-LD In patients undergoing cardiac surgery for indications
other than aortic valve repair or replacement who have a
concomitant aneurysm of ascending aorta with a maximum
diameter of ≥5.0 cm, ascending aortic replacement may be
reasonable.
2a C-LD 6. In patients with a height >1 standard deviation above or
below the mean who have an asymptomatic aneurysm of
the aortic root or ascending aorta and a maximal cross-
sectional aortic area/height ratio of ≥10 cm
2
/m, surgery is
reasonable when performed by experienced surgeons in a
Multidisciplinary Aortic Team.
2b C-LD 7. In asymptomatic patients with aneurysms of the aortic root
or ascending aorta who have either an ASI of ≥3.08 cm/m
2
or AHI of ≥3.21 cm/m, surgery may be reasonable when
performed by experienced surgeons in a Multidisciplinary
Aortic Team.
