Impact of ascending aortic length to detect surgical intervention for ascending aortic aneurysms

Objective: Ascending aortic length (AAL) has recently garnered attention as an additional parameter of surgical indication. This study aimed to verify that AAL is extended in ascending aortic aneurysm patients when compared with the normal aorta. Methods: The study included 132 patients who were diagnosed with true ascending aortic aneurysms from January 2002 to December 2021. The AAL was measured as the distance from the aortic annulus to the origin of the innominate artery. The data of 295 patients who underwent transcatheter aortic valve replacement during same period were compiled as the control group. In order to index AAL, it was divided by the patient’s height (Length height index, LHI). Results: The mean ascending aortic diameter (AAD) and AAL in the 132 patients were 5.3 ± 0.6 cm and 11.7 ± 1.6 cm, respectively. Propensity score matching revealed a significantly longer AAL in the aortic aneurysm group than in the control group (11.7 vs. 8.8 cm, P < 0.05). The LHI in the aortic aneurysm group was significantly greater than in the control group (7.4 vs. 5.7 cm/m, P < 0.05). The relationship between AAD and LHI was analyzed using linear regression analysis. The regression coefficient was 0.59, and the intercept was 4.22. As a tool to predict LHI, the formula: LHI = 0.59 × AAD + 4.22 was obtained. Conclusions: AAL and LHI were significantly increased in patients with ascending aortic aneurysms. Consequently, LHI may serve as an accurate indicator of surgical intervention.