A Metaanalysis and Systematic Review of Wrapping of the Ascending Aorta

Abstract

The results of the metaanalysis suggest that external aortic wrapping may be considered as a safe operative technique. In patients with a moderately dilated aorta it offers good mid-term and long-term outcome compared to replacement of the ascending aorta.

Wrapping of the ascending aorta revisited—is there any role left for conservative treatment of ascending aortic aneurysm?

“…In a more recent study, Zhang et al found that the use of blood products and the duration of postoperative hospital stay were also lower in patients who underwent wrapping than in those who underwent AA replacement (33). These findings have been confirmed in a recent meta-analysis of five studies that compare the results of wrapping and RAA (30). On the contrary, Lee et al did not find differences regarding mortality or the incidence of major postoperative complications between both techniques (9).…”

“…Hospital mortality in the more than 700 patients included in the meta-analysis by Plonek was only 1.5%, and the deaths were unrelated to the surgical technique (30). No mortality was recorded on patients who underwent isolated wrapping or wrapping associated with AA plication, whereas it increased to 2% in patients who underwent concomitant aortoplasty with resection of the aortic wall.…”

“…In addition, there are no prospective studies that compare the results of wrapping with those of RAA. Also, we have only found a recent meta-analysis in which Plonek et al analyze the results of wrapping, with and without reduction aortoplasty, in 722 patients (30). Only 4 out of the 17 studies included in this systematic review refer to patients-272-in which wrapping was performed alone, without an associated aortoplasty.…”

“…In another study with a longer follow-up period, Choi et al found that the 10-year freedom from cardiac-related death was similar in patients with bicuspid aortic valve in which only the valvular disease was corrected (91.7%) and in those who also underwent AA wrapping (89.3%) (32). Only 2 out of the 722 (0.3%) patients included in the meta-analysis carried out by Plonek, in which the average follow-up time was 5 years, died due to complications related to the aorta, one due to an acute dissection and the other during the reoperation to treat the re-dilatation of the aorta (30). However, some studies describe cases of sudden death in patients in which no measures were taken on the AA, and this did not happen in patients who also underwent AA wrapping (9,32).…”

“…Consequently, the need to reoperate on patients who undergo AA wrapping for re-dilatation of the aorta is low (18,19,31). Only 12 (1.7%) of the 722 patients included in the meta-analysis performed by Plonek had significant dilatation of any aortic segment during follow-up and only 13 (1.8%) required reoperation due to a residual or recurrent aortic pathology (30). In this systematic review, only 5 cases of aortic dissection were recorded during the follow-up and only one of those cases was acute.…”