A.5. What are the risk factors for TAA-associated mortality?
Answer:
Older age, female sex, New York Heart Association (NYHA) class, and baseline maximum aneurysm size (Table 9.1) have independent associations with aneurysm-related and all-cause mortality, while frailty, previous cardiac interventions, COPD, and lower body mass index (BMI) are additional risk factors. Each 1-cm increase in the maximal diameter more than doubles the risk of death. The hinge points for increased risk of aortic aneurysm rupture or dissection are 6.0 cm for the ascending aorta and 7.0 cm for the descending aorta, such that 31% and 43% of patients, respectively, will have experienced aneurysm-related complications at these stages of aneurysm growth.
Table 9.1: Annual Mortality Due to Aneurysm-Related Events (Rupture or Dissection) for Thoracic Aneurysms
| Maximum Baseline Size of Aneurysm (cm) | Aneurysm-Related Mortality (%) |
|---|---|
| 4-6 | <10 |
| 7 | 12.4 |
| 8 | 22.2 |
References
- Chau KH, Elefteriades JA. Natural history of thoracic aortic aneurysms: size matters, plus moving beyond size. Prog Cardiovasc Dis. 2013;56:74-80.
- Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002;74:S1877-S1880; discussion S1892-S1898.
- Sharples L, Sastry P, Freeman C, et al. Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: the effective treatments for thoracic aortic aneurysms study. Eur Heart J. 2022;43:2356-2369.