Natural History of Small Ascending Aortic Aneurysms

The official guideline of the American College of Cardiology and American Heart Association (NEJM JW Cardiol Jun 2014 and J Am Coll Cardiol 2014; 63:2438) recommends ascending aortic aneurysm (AsAA) repair at a diameter of 55 mm for appropriate surgical candidates. However, expert opinion and the belief of many surgeons is that repair at a diameter as small as 45 mm is reasonable because of declining surgical mortality. To assess the natural history of these aneurysms, researchers conducted a meta-analysis of 20 observational studies of small AsAAs (total of 8800 patients; mean age, 58; 76% men; mean AsAA diameter, 43 mm). Studies were eliminated if they included patients with descending aortic or combined aneurysms, genetic-related aneurys…