Commentary: Measure twice, cut once

Central MessageIntraoperative direct caliper measurements of the ascending aorta correlate well with preoperative CT and TTE at a high-volume aortic institution.See Article page e143. Intraoperative institution. See The risk rupture dissection is directly related to diameter according Laplace's law. For more than 2 decades, natural history studies from Aortic Institute Yale-New Haven Hospital have emphasized increased incidence complications larger diameters.1Coady M.A. Rizzo J.A. Hammond G.L. Mandapati D. Darr U. Kopf G.S. et al.What appropriate size criterion for resection thoracic aneurysms?.J Thorac Cardiovasc Surg. 1997; 113 (discussion 89-91): 476-491Abstract Full Text PDF PubMed Scopus (410) Google Scholar,2Chau K.H. Elefteriades Natural aneurysms: matters, plus moving beyond size.Prog Dis. 2013; 56: 74-80Crossref (49) Scholar Diameter-based thresholds, based on radiographic findings, are critical consideration surgical decision-making form basis clinical practice guidelines repair.3Hiratzka L.F. Bakris Beckman al.2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM diagnosis management patients disease. A report American College Cardiology Foundation/American Heart Association task force guidelines, Thoracic Surgery, Radiology, Stroke Association, Society Cardiovascular Anesthesiologists, Angiography Interventions, Interventional Surgeons,and Vascular Medicine.J Am Coll Cardiol. 2010; 55: e27-e129Crossref (884) asymptomatic patients, timing operative repair largely determined by imaging studies; modalities include echocardiography (transthoracic [TTE] transesophageal), computed tomography (CT), magnetic resonance imaging. However, can be challenging image due motion, oblique course, variability measurement techniques, as recently described coauthors.4Elefteriades Mukherjee S.K. Mojibian H. Discrepancies in aorta: JACC review topic week.J 2020; 76: 201-217Crossref (10) In this current issue Journal, Vinholo coauthors5Vinholo T.F. Zafar Papanikolaou Chung J. Ellauzi Ziganshin B.A. al.Direct intraoperative assessment.J 2021; 161: e143-e146Google compared intraoperative, studies, primarily measurements. study 35 corresponded aorta. Nuances included exclusion wall angiography, inclusion via caliper, partial leading-edge-to-leading-edge techniques TTE. Despite inherent differences between measurements, such how was captured, authors found correlated measurement. Notably, because disease tied it reassuring that these approximate true obtained through use has limited value scheduling repair. dynamic scenarios which patient table other reasons (ie, valvular concerns or address coronary artery disease) presents unexpectantly, surgeon may gain confidence knowing highly established diameter-based thresholds coauthors provide key contribution empirically examining assumption correlates dimensions Even so, were measured surgery institution well-defined protocols not generalizable all institutions. coauthors4Elefteriades various sources discrepancy occur within modalities. Elsewhere, transcatheter community put forth an expert consensus context valve replacement.6Blanke P. Weir-McCall J.R. Achenbach S. Delgado V. Hausleiter Jilaihawi al.Computed implantation (TAVI)/transcatheter replacement (TAVR): document Computed Tomography.JACC Imaging. 2019; 12: 1-24Crossref (91) Similarly, surgeons should work together specialists standardizing we measure aorta, thereby strengthening foundation upon our rests. addition, literature describing aim precise when describe diameters technique. foreseeable future until better ways assess strength, thickness, integrity wall, will continue serve hinge point Direct assessmentThe Journal SurgeryVol. 161Issue 2PreviewThoracic aneurysm (TAA) silent but virulent Ascending TAAs grow roughly 0.1 cm/y they grow, silently, death increases significantly, making potentially lethal disease.1 Fortunately, intervention prevent catastrophic events essentially restore survival normal.2 single most predictive factor acute event diameter. Consequently, decision predicated dimensions. Full-Text