Midterm follow up in patients with reduction ascending aortoplasty

Abstract

BackgroundThe 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.MethodsFrom 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.ResultsAll 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.ConclusionReduction ascending aortoplasty without external wrapping is a safe procedure with acceptable midterm results in patients with asymptomatic dilatations and concomitant cardiac surgical procedures.

Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center’s Experience

“…However, RAA remains a controversial surgical option because of the potential risk of redilatation. It is generally limited to selected patients with high perioperative risks or is used as an added procedure with concomitant intervention [11][12][13].…”

Reduction ascending aortoplasty: A retrospective analysis of outcomes and risk factors

“…This is presumably based on exerted tension, stress, and pressure peaks, all increasing the early risk for tearing at the suture line. Noteworthy, the according risk is increased in aortas with rigid and thinned walls ( 14 ), predisposing to suture line bleeding and aortic rupture ( 5 , 6 ). Potential late complications include redilatation and aneurysm progression or dissection.…”

“…Current guidelines recommend ascending aneurysm replacement at aortic diameters of 55 mm in patients with tricuspid aortic valves (TAV), or 50 mm in patients with bicuspid aortic valves (BAV) in presence of risk factors or in patients with genetic connective tissue disorders (1,2). Although RAA is not recommended as the firstline procedure, it is suggested applicable in patients of higher age and unfit for extended aortic surgery (1), while connective tissue disorders are clear contraindications (3)(4)(5). High preoperative aortic diameters are assumed to promote redilatation (6,7) and in bicuspid aortic valves (BAV), aortic redilatation after RAA is suspected due to underlying histopathologic aortic wall changes (8).…”

Surgical repair of the moderately dilated ascending aorta combined with bicuspid aortic valve replacement

“…Аортопластику можно дополнять обертыванием ВА участком сосудистого протеза для укрепления стенки аорты [30]. Несмотря на определенную дискутабельность, ряд исследователей приводят данные в пользу безопасности, эффективности редукционной пластики и/или наружного обертывания ВА и о низком числе отдаленных осложнений [15,25,31,32]. Некоторые исповедуют персонифицированный подход к коррекции сопутствующего расширения ВА при протезировании ДАК [33].…”