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Long Term Results of Reduction Ascending Aortoplasty. Life (Basel) 2022; 12:life12101526. [PMID: 36294961 PMCID: PMC9605633 DOI: 10.3390/life12101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
The aim of this retrospective study is to show medium-long-term results in terms of cardiac death and aortic events in patients undergoing reduction ascending aortoplasty between 1997 and 2009 in our hospital. The Fine and Grey model for competing risk analysis was performed for time to cardiac death, with non-cardiac death as the competing risk, and time to recurrence of both re-dilation (aortic diameter > 45 mm) and re-operation with overall death as the competing risk. Paired t-test was used to evaluate the change in aortic diameter from the post-operative values to follow-up. The population included 142 patients. The mean pre-operative aortic diameter and the diameter at follow-up were respectively 46.5 ± 5.11 mm vs. 41.4 ± 5.55 mm (p-value < 0.001). At a mean follow-up of 11.6 ± 4.15 years, 11 patients (7.7%) required re-operation on the ascending aorta. At 16 years, the CIF of aortic-related events was 29.4 ± 7.2%; the freedom from cardiac death was 89.2 ± 3.7%. Ten patients (7%) died from cardiac causes but no one was aortic-related. The Fine and Grey analysis did not identify any significant predictors. This procedure is safe but might be justified only in high-risk patients or in those with advanced age/short life expectancy.
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Szalkiewicz P, Gökler J, Dietl W, Ehrlich M, Holzinger C, Laufer G, Wiedemann D. Reduction ascending aortoplasty: A retrospective analysis of outcomes and risk factors. Front Cardiovasc Med 2022; 9:953672. [PMID: 35958409 PMCID: PMC9357918 DOI: 10.3389/fcvm.2022.953672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/30/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Indication for Reduction of Ascending Aortoplasty (RAA) and long-term outcomes remain unclear. This study analyzed the outcomes after nonreinforced RAA in two Austrian centers. Methods Patients with RAA at two Austrian centers between 6/2,009 and 6/2,017 were retrospectively analyzed. Aortic diameters were measured by CT pre- and post-operatively. Patients were assigned according to valve morphology and imaging modality. Results Overall, 253 patients underwent RAA [women: 30.8%; median age 74 (63–79) years] with a mean preoperative ascending diameter of 44.7 (±3.5) mm. RAA-related postoperative adverse events occurred in 1.2% (n = 3) over a follow-up of a median of 3.8 (2.4–5.5) years: One type A aortic dissection, one lethal aortic rupture at the suture line, and one suture line bleeding with cardiac tamponade and need of surgical revision. The overall survival rate was 89.7%. Aortic valve morphology itself was no risk factor for mortality (Log-Rank: 0.942). One hundred and forty patients had a tricuspid [TAV: (55.3%)] aortic valve and 113 patients had a bicuspid aortic valve [BAV: (44.7%)]. Redilatation to a diameter >50 mm according to CT follow-up occurred in 5.7% (n = 5 of 87). One patient needed reoperation with RAA and aortic valve replacement due to a prosthesis-patient mismatch after aortic valve replacement and aortic redilatation. Conclusion Non-reinforced RAA is a safe, feasible, and reproducible procedure with low rates of perioperative complications in selected patients primarily undergoing aortic valve repair with a dilated ascending aorta. Aortic valve morphology has no impact on mortality after RAA.
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Affiliation(s)
- Philipp Szalkiewicz
- Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Gökler
- Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Johannes Gökler
| | - Wolfgang Dietl
- Clinical Department of Cardiac Surgery, University Hospital of St. Pölten, St. Pölten, Austria
| | - Marek Ehrlich
- Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Holzinger
- Clinical Department of Cardiac Surgery, University Hospital of St. Pölten, St. Pölten, Austria
| | - Günther Laufer
- Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
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Lee Y, Hwang HY, Park EA, Jang MJ, Sohn SH, Choi JW. Suture reduction of the borderline ascending aortic dilatation during aortic valve replacement. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:618-624. [PMID: 34014057 DOI: 10.23736/s0021-9509.21.11543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was conducted to evaluate the efficacy of simple suture reduction of the ascending aorta(SRA) performed with aortic valve replacement(AVR) in patients with borderline ascending aortic dilatation(45-50mm). METHODS 98 patients (ascending aortic diameter=47.7±3.4mm) who underwent concomitant SRA with AVR were enrolled. Median follow-up duration was 83 (interquartile=27,173) months. Computed tomographic angiography(CTA) follow-up was performed at 71(47,149) months after surgery(n=69). At least two CTA scans were performed in 34 patients (interval=63[46,156] months). Early and long-term outcomes were evaluated, and dilatation rate (mm/year) of the repaired aorta was analyzed. Major adverse aortic events(MAEs) were defined as death related to aortic events, including sudden death, aortic rupture or dissection, aortic reoperation and recurrent aortic aneurysm(>45mm). RESULTS Early mortality rate was 2.0%. No patients had postoperative complications associated with SRA. A recurrent aortic aneurysm(>45mm) was found in 9 patients, but none of the patients had an ascending aorta diameter>50mm. A multivariable analysis demonstrated that neither preoperative diameter of the ascending aorta nor bicuspid valve was associated with dilatation of the repaired aorta. Co-existing coronary artery disease was associated with both recurrent aneurysm and increased dilatation rate after SRA. There were 2 cases of sudden death and no one suffered from aortic dissection, rupture or aortic reoperation. Ten- and 20-year freedom rates from MAE were 90.3% and 79.3%, respectively. CONCLUSIONS Concomitant SRA might be a safe and effective surgical alternative to ascending aorta replacement in AVR patients with borderline ascending aortic dilatation regardless of aortic valve pathology.
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Affiliation(s)
- Yeiwon Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea
| | - Ho Y Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea -
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea
| | - Suk H Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea
| | - Jae W Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea
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Liu S, Shi Y, Liu R, Tong M, Luo X, Xu J. Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center’s Experience. Ann Thorac Surg 2017; 103:511-516. [DOI: 10.1016/j.athoracsur.2016.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
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Na KJ, Kim JS, Park KH, Lim C. Wrapping of an Ascending Aortic Aneurysm with the Multiple Boot-Straps Technique in a Patient Undergoing Off-Pump Coronary Artery Bypass Grafting. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:206-9. [PMID: 26078929 PMCID: PMC4463225 DOI: 10.5090/kjtcs.2015.48.3.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022]
Abstract
Ascending aortic aneurysms are usually treated with graft replacement under cardiopulmonary bypass. However, if a candidate for off-pump coronary artery bypass grafting has an enlarged ascending aorta, surgeons may consider wrapping it without cardiopulmonary bypass. Here, we report a 78-year-old female who underwent successful wrapping of the ascending aorta concomitant with off-pump coronary artery bypass grafting, using a new wrapping technique that involves multiple bootstraps.
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Affiliation(s)
- Kwon Joong Na
- Departments of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
| | - Jun Sung Kim
- Departments of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
| | - Kay-Hyun Park
- Departments of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
| | - Cheong Lim
- Departments of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
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Kiessling AH, Odwody E, Miskovic A, Stock UA, Zierer A, Moritz A. Midterm follow up in patients with reduction ascending aortoplasty. J Cardiothorac Surg 2014; 9:120. [PMID: 24996647 PMCID: PMC4104728 DOI: 10.1186/1749-8090-9-120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reduction ascending aortoplasty in patients with an aortic ectasia/dilatation is a common procedure during concomitant cardiac operations. Aim of the follow up study was the evaluation of possible re-dilatation and complications. METHODS From 1998 to 2010 124 patients (69% male; mean age 66.6 ± 12 ys) with ectasia of the ascending aortic who had no further indication for an aortic replacement, were included. The mean preoperative diameter of the ascending aorta was 4.2 ± 0.6 cm. The patients risk profile was moderate (mean EF 51% ± 11%, Euroscore 4.2 ± 2.1). To treat the dilatation of the ascending aorta, a longitudinal incision was performed and a strip of the aortic wall was resected. A reduction aortoplasty was carried out with a double-layered suture line using a 4/0 Prolene mattress suture with an additional 4/0 Prolene running suture. A follow up (rate 95%) was performed by echocardiography- and clinical examination. RESULTS All patients underwent reduction aortoplasty associated with a primary cardiac surgical procedure (AVR 63%, CABG 13%, other or combination 24%). The intrahospital mortality rate was 4%. Four aortic bleeding complications occurred. After a mean postoperative period of 57 ± 39 months, the ascending aortic diameter (3.6 ± 0.6 cm) was still significantly (P < 0.01) reduced. No postoperative aortic-related complications including aortic rupture, dissection and reoperation were observed. In 4 patients, the ascending aorta had re-dilated to the preoperative diameter. CONCLUSION Reduction ascending aortoplasty without external wrapping is a safe procedure with acceptable midterm results in patients with asymptomatic dilatations and concomitant cardiac surgical procedures.
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Affiliation(s)
- Arndt H Kiessling
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, Frankfurt am Main 60590, Germany.
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Ozcan AV, Alşalaldeh M, Boysan E, Goksin I. Ascending Aortic Aneurysm Treatment With Linear Plication and External Wrapping Technique: Mid-Term Results. J Card Surg 2013; 28:421-6. [DOI: 10.1111/jocs.12139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Vefa Ozcan
- Department of Cardiovascular Surgery; Pamukkale University; Denizli Turkey
| | | | - Emre Boysan
- Department of Cardiovascular Surgery; Denizli Education and Research Hospital; Denizli Turkey
| | - Ibrahim Goksin
- Department of Cardiovascular Surgery; Pamukkale University; Denizli Turkey
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Sasaki H, Ishitoya H, Sasaki O. A Case of Acute Aortic Dissection with Intimal Tear Found at 1 cm Above Previous Aortotomy. Ann Vasc Dis 2013; 6:84-6. [PMID: 23641290 DOI: 10.3400/avd.cr.12.00069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/30/2012] [Indexed: 11/13/2022] Open
Abstract
Although it is rare, acute aortic dissection after cardiac surgery predisposes the patients to critical condition such as rupture, tamponade and death. Prompt diagnosis and treatment is mandatory for this fatal complication. We present our case in which acute aortic dissection occurred 7 years after aortic valve replacement.
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Affiliation(s)
- Hideki Sasaki
- Department of Cardiovascular Surgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
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Della Corte A, De Feo M, Bancone C, Provenzano R, Giordano S, Buonocore M, Nappi G, Cotrufo M. Long-term follow-up of reduction ascending aortoplasty with autologous partial wrapping: for which patient is waistcoat aortoplasty best suited? Interact Cardiovasc Thorac Surg 2011; 14:56-63. [PMID: 22108923 DOI: 10.1093/icvts/ivr007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the early and long-term outcomes of a previously introduced technique of reduction aortoplasty for asymmetric ascending aortic dilatation. Different indication criteria for reduction ascending aortoplasty have been previously adopted by others, thus another purpose was to identify the patient profile for whom this approach may be best suited. METHODS Between January 2001 and December 2010, reduction ascending aortoplasty with "waistcoat technique" was performed in 156 patients (mean age 62 ± 12 years, 61% male) with asymmetric dilatation of the ascending aorta (prevailing at the convexity of the supracoronary tract). Eighty-seven patients had a tricuspid aortic valve (TAV), 69 a bicuspid aortic valve (BAV). Aortoplasty was associated to aortic valve replacement in 60% cases. Preoperative, intraoperative, early postoperative and follow-up data were analysed. Comparisons were performed between groups of valve morphology (TAV versus BAV) and subgroups of baseline valve function. In patients with a follow-up time >1 year the annual growth of the ascending tract was calculated and compared between subgroups. The independent predictors of growth velocity were assessed by multivariable linear regression analysis. RESULTS Mean cross-clamp and cardiopulmonary bypass times were 39 ± 18 and 69 ± 29 min, respectively. Hospital death was 1.9%. In no case, postoperative death or any early complication was causally related to the aortoplasty procedure. The mean postoperative ascending diameter was 3.1 ± 0.3 (versus preoperative 5.2 ± 0.8 cm, P < 0.001). Mean follow-up time was 4 ± 2.5 years (maximum 10 years): 7-year survival was 95 ± 2%; 7-year freedom from aortic events 94 ± 4%. Redilatation (ascending diameter exceeding 4.5 cm) occurred in two patients, acute dissection in one: all three preoperatively had significant aortic regurgitation. The mean ascending aortic diameter at last follow-up was 3.4 ± 0.5 cm; median diameter progression was 0.4 mm/year, with no significant difference between TAV and BAV and no patient reaching 0.5 cm/year. With TAV, the only determinant of aortic growth rate was normal preoperative valve function (P = 0.04); with BAV, the degree of regurgitation at preoperative echocardiography (P = 0.001). CONCLUSIONS Waistcoat aortoplasty proved a safe and durable treatment for patients with asymmetric non-syndromic non-familial ascending aorta dilatation. The technique showed its best durability in aortic stenosis patients and in patients with normofunctional BAV.
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Affiliation(s)
- Alessandro Della Corte
- Department of CardioThoracic Sciences, Second University of Naples, Monaldi Hospital, Naples, Italy.
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Zhang H, Lu F, Qu D, Han L, Xu J, Ji G, Xu Z. Treatment of fusiform ascending aortic aneurysms: A comparative study with 2 options. J Thorac Cardiovasc Surg 2011; 141:738-43. [DOI: 10.1016/j.jtcvs.2010.05.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 03/21/2010] [Accepted: 05/17/2010] [Indexed: 11/16/2022]
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Hwang HY, Shim MS, Park EA, Ahn H. Reduction aortoplasty for the ascending aortic aneurysm with aortic valve disease. Does bicuspid valve matter? Circ J 2010; 75:322-8. [PMID: 21157105 DOI: 10.1253/circj.cj-10-0792] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The outcomes of reduction ascending aortoplasty (RAA) performed with aortic valve surgery were evaluated and the results of RAA in patients with bicuspid aortic valve (BAV) were compared with those in patients with tricuspid valve. METHODS AND RESULTS From October 1994 to April 2009, 88 patients underwent RAA. Aortic valve was bicuspid in 45 patients (BAV group) and tricuspid in 43 patients (TAV group). Total circulatory arrest was required in 45 patients. Preoperative ascending aortic diameter was 45.5±4.7mm. Early mortality rate was 1.1%. Ten-year survival rate and freedom from cardiac death were 91.1% and 96.2%, respectively. No differences in clinical outcomes were found between the 2 groups. No aorta-related complications including aortic rupture, dissection and reoperation were observed. Aortic diameter at the last follow-up (61±43 months) was 37.8±4.3mm. The interval between surgery and follow-up CTA was associated with aneurysmal recurrence (P=0.022). Average rate of dilatation was 0.42±0.49mm/year (n=37). A need for total circulatory arrest was associated with an increase of the aortic diameter (P=0.009). BAV was associated with neither aneurysmal recurrence nor increase of aortic diameter. CONCLUSIONS RAA in patients with an ascending aortic aneurysm combined with aortic valve disease could be performed with acceptable early and long-term outcomes, even in patients with BAV. Long-term follow-up evaluation might be necessary due to the risk of redilatation especially in patients with an extended aneurysm, which required total circulatory arrest for RAA.
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Affiliation(s)
- Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Vallely MP, Semsarian C, Bannon PG. Management of the ascending aorta in patients with bicuspid aortic valve disease. Heart Lung Circ 2008; 17:357-63. [PMID: 18514024 DOI: 10.1016/j.hlc.2008.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 12/05/2007] [Accepted: 01/23/2008] [Indexed: 01/11/2023]
Abstract
Bicuspid aortic valve (BAV) disease is the most common form of congenital heart disease, affecting 1-2% of the population. Only 20% of patients will maintain normal valve function throughout their life and more than 30% of patients will develop serious morbidity. It is a highly heritable condition, with transmission likely to be autosomal dominant. Patients with BAV have a 10-fold risk of aortic dissection when compared to the normal population. Management of BAV associated aortopathy represents a significant clinical challenge.
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Feindt P, Litmathe J, Börgens A, Boeken U, Kurt M, Gams E. Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery? Eur J Cardiothorac Surg 2007; 31:614-7. [PMID: 17306983 DOI: 10.1016/j.ejcts.2007.01.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 12/31/2006] [Accepted: 01/04/2007] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Enlargement of the ascending aorta is often combined with valvular, coronary, or other cardiac diseases. Reduction aortoplasty can be an optional therapy; however, indications regarding the diameter of aorta, the history of dilatation (poststenosis, bicuspid aortic valve), or the intraoperative management (wall excision, reduction suture, external reinforcement) are not established. METHODS In a retrospective study between 1997 and 2005, we investigated 531 patients operated for aneurysm or ectasia of the ascending aorta (diameter: 45-76mm). Of these, in 50 patients, size-reducing ascending aortoplasty was performed. External reinforcement with a non-coated dacron prosthesis was added in order to stabilize the aortic wall. RESULTS Aortoplasty was associated with aortic valve replacement in 47 cases (35 mechanical vs 12 biological), subvalvular myectomy in 29 cases, and CABG in 13 cases. The procedure was performed with low hospital mortality (2%) and a low postoperative morbidity. Computertomographic and echocardiographic diameters were significantly smaller after reduction (55.8+/-9mm down to 40.51+/-6.2mm (CT), p<0.002; 54.1+/-6.7mm preoperatively down to 38.7+/-7.1mm (echocardiography), p<0.002), with stable performance in long-term follow-up (mean follow-up time: 70 months). CONCLUSIONS As demonstrated in this study, size reduction of the ascending aorta using aortoplasty with external reinforcement is a safe procedure with excellent long-term results. It is a therapeutic option in modern aortic surgery in patients with poststenotic dilatation of the aorta without impairment of the sinotubular junction of the aortic valve and root.
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Affiliation(s)
- Peter Feindt
- Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Düsseldorf, Germany
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Walker T, Bail DHL, Gruler M, Vonthein R, Steger V, Ziemer G. Unsupported Reduction Ascending Aortoplasty: Fate of Diameter and of Windkessel Function. Ann Thorac Surg 2007; 83:1047-53. [PMID: 17307457 DOI: 10.1016/j.athoracsur.2006.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 10/07/2006] [Accepted: 10/11/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Moderate aneurysms of the ascending aorta that are associated with other cardiac diseases are frequently encountered by cardiac surgeons. Reduction ascending aortoplasty (RAA) provides an elegant technique to handle these aneurysms; however, its applicability is still under debate. Many surgeons reject RAA because of an assumed redilatation. We investigated the postoperative stability of RAA without external support and whether the elastic property of the aorta (Windkessel function) remains preserved. METHODS From 1996 to 2003, 97 patients (mean age, 67 years) underwent RAA without external stabilization in our institution as a concomitant procedure during cardiac surgery. The diameter of the ascending aorta was measured before and directly after surgery, as well as postoperatively from 10 to 96 months (median, 32 months). RESULTS The mean preoperative diameter was 4.55 +/- 0.43 cm, while the early postoperative diameter measured 3.53 +/- 0.44 cm. Fifty-four of the 97 patients were available for follow-up. The mean diameter measured at follow-up was 3.68 +/- 0.41 cm. The mean increase was 0.17 +/- 0.27 cm. There was no relevant difference in redilatation between patients with follow-up of more than 60 months or less. Furthermore, the aortic wall demonstrated a near normal diastolic-systolic augmentation assessed by echocardiography. CONCLUSIONS Reduction ascending aortoplasty without external stabilization is a reliable treatment for patients suffering from a moderately enlarged ascending aorta who require cardiac surgery for other indications. In these cases, with the technique described, a redilatation can be prevented and the Windkessel function of the ascending aorta remains preserved.
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Affiliation(s)
- Tobias Walker
- Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany.
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