A prospective study of growth and rupture risk of small-to-moderate size ascending aortic aneurysms

ObjectiveThe natural history of small-to-moderate size ascending aortic aneurysms is poorly understood. To follow these patients better, we have developed a method to objectively and reproducibly measure ascending aortic volume on the basis of gated contrast computed tomography scans.MethodsFrom 2009 to 2011, 507 patients were referred for management of ascending aortic aneurysms. A total of 232 patients (46%) with small-to-moderate size aneurysms who did not have compelling indications for operation had measurement(s) of ascending aortic and total aortic volume; 166 patients had more than 1 scan, allowing measurement of growth. A total of 66 patients admitted to the emergency department without ascending aortic pathology served as a reference group.ResultsNone of the patients experienced rupture, dissection, or death; 3 patients ultimately underwent operation. Ascending aortic volume and volume/total aortic volume differed for the surveillance and reference groups: 132.8 ± 39.4 mL versus 78.0 ± 24.5 mL; 38.3% ± 7.4% versus 29.1% ± 3.9%, respectively (both P < .001). Diameters at the sinotubular junction and mid-ascending aortic were 4.1 ± 0.6 cm and 4.4 ± 0.6 cm, respectively, for the surveillance group and 3.0 ± 0.4 cm and 3.2 ± 0.4 cm, respectively, for controls. The increase in ascending aortic volume was 0.95 ± 4.5 mL/year and 0.73% ± 3.7%/year (P = .007 and .012, respectively). Analysis of risk factors for ascending aortic growth revealed only the use of antithrombotic medication as possibly significant.ConclusionsComputed tomography volume measurements provide an objective method for ascertaining aortic size and monitoring expansion. Patients with small-to-moderate ascending aortic aneurysms who are carefully followed and managed appropriately have slow aneurysm growth and a small risk of rupture or dissection. Annual computed tomography screening may not be indicated, and elective resection—absent other surgical indications—is not necessary. The rupture/dissection risk for even larger aneurysms in carefully followed patients may be lower than currently believed

Right hepatectomy for living donation: Role of remnant liver volume in predicting hepatic dysfunction and complications

BACKGROUND: Extensive attention has been placed on remnant liver volume (RLV) above other factors to ensure donor safety. METHODS: We performed a retrospective review of 137 right hepatectomies in live donors between June 1999 and November 2010. RESULTS: Median right lobe volume was 1,029 cm(3), which correlated with its actual weight (r = 0.63, P 3 mg/dL or prothrombin time >18 s on postoperative day 4). RLV did not predict postoperative hepatic dysfunction (P = .9), but it was associated with peak international normalized ratio (INR) (P = .04). Donor age and male gender were predictors of increased bilirubin at postoperative day 4 (age, P = .03; gender, P = .02). Of the donors, 45 (33%) experienced complications, and 24 donors had RLVs <30%; 42% experienced complications compared to 31% of donors whose RLVs were greater than 30% (P = .3). Cell-saver utilization and aspartate-aminotransferase (AST) levels (OR = 3) were associated with complications. Volumetric assessment can predict RLV accurately. CONCLUSION: Although no demonstrable association between RLV <30% and complications was found, an RLV of 30% should remain the threshold for donor safety. Age and gender should be balanced in donors with a near threshold RLV of 30%. Surgical complexity, suggested by the need for intraoperative autoinfusion of blood and postoperative levels of AST, remained the independent predictor of complications.Fil: Facciuto, Marcelo. Mount Sinai Medical Center; Estados UnidosFil: Contreras Saldivar, Alan. Mount Sinai Medical Center; Estados UnidosFil: Singh, Manoj K.. Mount Sinai Medical Center; Estados UnidosFil: Rocca, Juan Pablo. Mount Sinai Medical Center; Estados UnidosFil: Taouli, Bachir. Mount Sinai Medical Center; Estados UnidosFil: Oyfe, Irina. Columbia University; Estados UnidosFil: LaPointe Rudow, Dianne. Mount Sinai Medical Center; Estados UnidosFil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Schiano, Thomas. Mount Sinai Medical Center; Estados UnidosFil: Kim Schluger, Leona. Mount Sinai Medical Center; Estados UnidosFil: Schwartz, Myron E.. Mount Sinai Medical Center; Estados UnidosFil: Miller, Charles M.. Cleveland Clinic. Digestive Disease Institute. Department of Hepato-Pancreato-Biliary and Transplant Surgery ; Estados UnidosFil: Florman, Sander. Mount Sinai Medical Center; Estados Unido