Ascending Aortic Aneurysm Treatment With Linear Plication and External Wrapping Technique: Mid-Term Results

Abstract

Linear plication with external wrapping is a therapeutic option with promising mid-term results, in carefully selected, high surgical risk patients with an ascending aortic aneurysm.

A Metaanalysis and Systematic Review of Wrapping of the Ascending Aorta

“…Eighty‐seven percent of all patients needed a concomitant aortic valve operation (replacement, repair). Of the 722 patients, 272 were treated by means of the wrapping technique (group W), 350 using wrapping with concomitant resection aortoplasty (part of the excessive aortic wall was excised—group WAR), and 100 utilizing wrapping with concomitant plication aortoplasty (the excessive aortic wall was plicated—group WAP) . Hospital mortality was 0.4%, 2%, and 0% in groups W, WAR, and WAP, respectively.…”

“…Seventeen papers were selected for analysis of wrapping with and without concomitant aortoplasty through database and hand searching [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] (Fig. 1).…”

“…This may be the reason for fewer complications (redilatation, wall degeneration, dissection) in patients with wrapping without reduction aortoplasty. An aortoplasty with wrapping probably does not offer additional advantages over an isolated wrapping in moderately dilated aorta 9,18,[21][22][23] Wrapping R Aortoplasty (Wall Resection) 4,8,10,[13][14][15][16][17][18][19][20] Wrapping R Aortoplasty (Wall Plication) 3,11,12,17,24 (40 to 55 mm). However, this combined technique may be useful when dealing with the aorta of a greater diameter as it could prevent aortic wall deformation.…”

“…Of the 722 patients, 272 were treated by means of the wrapping technique (group W), 9,18,[21][22][23] 350 using wrapping with concomitant resection aortoplasty (part of the excessive aortic wall was excised-group WAR), 4,8,10,[13][14][15][16][17][18][19][20] and 100 utilizing wrapping with concomitant plication aortoplasty (the excessive aortic wall was plicated-group WAP). 3,11,12,17,24 Hospital mortality was 0.4%, 2%, and 0% in groups W, WAR, and WAP, respectively. There were no cases of early aortic mortality in either group and two cases of late aortic deaths were noted in group WAR (0.6% of 350 patients).…”

Aortic Wrapping for a Dilated Ascending Aorta in Bicuspid Aortic Stenosis

“…In the previous reports, secure anchoring of the wrap was emphasized 10,17 or a plicating suture of the aorta and the wrapping graft was suggested to prevent it. 34 Hwang et al reported reduction aortoplasty without aortic wrapping and acceptable long-term outcomes. 35 …”