{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:28:56Z","timestamp":1790299736184,"version":"4.1.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T00:00:00Z","timestamp":1606089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,13]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>As thoracic aortic aneurysm disease continues to cause significant morbidity and mortality in the general population, the cardiovascular community continues the search for the golden threshold of elective surgical replacement of the ascending aorta.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Thoracic aortic aneurysm is a common disease, classified within the 20 most common causes of death in patients over 65\u2009years old. Once aortic complications like dissection or rupture occur, they can prove fatal. Prophylactic surgical replacement of the ascending aorta remains the mainstay of treatment to prevent these complications. Current American and European guidelines agree that the threshold for the diameter for elective replacement of the ascending aorta in non-syndromic, asymptomatic aneurysmal disease is 5.5\u2009cm. Overall, aortic dissection is related to poor prognosis, thus making early intervention paramount.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>There is a critical size above which the risk of dissection or rupture becomes extremely high. However, a significant post-dissection increase in diameter is reported, thus rendering the predissection aortic diameter well below the current threshold for elective surgical replacement of the ascending aorta. Moreover, it is widely reported that the majority of acute aortic dissections would not meet the criteria for prophylactic surgery prior to dissection. Additionally, elective surgical ascending aortic replacement in the current era shows a significantly improved risk-benefit ratio, which justifies a more aggressive approach in the management of aortic aneurysmal disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>As a result, there is a lot of discussion in the literature about the requirement of a leftward shifting of the surgical threshold for elective aortic replacement.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa387","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T11:18:38Z","timestamp":1600946318000},"page":"554-561","source":"Crossref","is-referenced-by-count":19,"title":["Elective replacement of the ascending aorta: is the 5.5-cm threshold appropriate? The insidious, small aorta"],"prefix":"10.1093","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1272-7990","authenticated-orcid":false,"given":"Nikolaos A","family":"Papakonstantinou","sequence":"first","affiliation":[{"name":"3rd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippos-Paschalis","family":"Rorris","sequence":"additional","affiliation":[{"name":"Cardiovascular and Thoracic Surgery Department, General Hospital of Athens \u201cEvangelismos\u201d, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,23]]},"reference":[{"key":"2021050518294003000_ezaa387-B1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.gheart.2013.12.010","article-title":"Global and regional burden of aortic dissection and aneurysms: mortality trends in 21 world regions, 1990 to 2010","volume":"9","author":"Sampson","year":"2014","journal-title":"Glob Heart"},{"key":"2021050518294003000_ezaa387-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11748-017-0874-x","article-title":"Thoracic aortic aneurysm: unlocking the \u201csilent killer\u201d secrets","volume":"67","author":"Saeyeldin","year":"2019","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2021050518294003000_ezaa387-B3","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jvs.2012.04.053","article-title":"Natural history of thoracic aortic aneurysms","volume":"56","author":"Kuzmik","year":"2012","journal-title":"J Vasc Surg"},{"key":"2021050518294003000_ezaa387-B4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1053\/j.semtcvs.2015.07.006","article-title":"Treatment of thoracic aortic aneurysm: role of earlier intervention","volume":"27","author":") Ziganshin","year":"2015","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2021050518294003000_ezaa387-B5","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1016\/j.jacc.2010.02.015","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. 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