Safe wrapping of the borderline dilated ascending aorta during aortic valve replacement

Tappainer, Ernesto; Fiorani, Vinicio; Nocchi, Andrea; Likaj, Ermal; Memishaj, Sabjan; Zogno, M.

doi:10.1186/1749-8090-2-15

Cited by 8 publications

(9 citation statements)

References 8 publications

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“…In order to prevent the formation of folds it is essential to adequately measure the necessary length of the graft and to apply the correct longitudinal tension. As an alternative to a straight graft, Tappainer et al proposed the creation of a slightly curved tubular support made up of two segments of a straight vascular prosthesis (21).…”

Section: Wrapping Techniquementioning

confidence: 99%

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

González-Santos

Arnáiz-García

2017

J. Thorac. Dis.

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Dilatation of the ascending aorta (AA) is a common finding in patients with aortic valve disease.The clinical practice guidelines recommend replacing the AA whenever the diameter exceeds 45 mm.However, no consensus has been reached regarding the approach when the aorta is only moderately dilated.Although the risk in aorta replacement is generally low, it may be higher when associated with other complex surgical procedures or it is carried out in elderly patients or patients with significant comorbidity. This would justify the use of alternative surgical techniques, which reduce surgical risk and guarantee a durable correction of the aortic pathology. Conservative treatment of aneurysms of the AA via wrapping with different synthetic materials has been implemented for many years. The most commonly used technical variant is wrapping the dilated aorta with a vascular prosthesis with a predetermined diameter. When this technique is adequately applied, it immediately reduces the diameter of the AA and, to a lesser degree, the diameter of the aortic root and arch, while at the same time it reinforces the weak aortic wall. These effects lead to a drop-in wall shear stress and in the risk of aortic dissection and rupture, and persist over time. Although the low elasticity of the external support causes significant changes in the histologic structure of the aortic wall, mainly atrophy and alterations typical of a foreign body-induced reaction, this does not seem to involve a higher risk of complications. In some selected patients, this technique may be used in cases other than post-stenotic aortopathy, and also in aortas with a larger diameter.

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Section: Wrapping Techniquementioning

confidence: 99%

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

González-Santos

Arnáiz-García

2017

J. Thorac. Dis.

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“…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].…”

Section: Discussionunclassified

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

et al. 2019

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Background: Ascending aortic (AA) dilatation is common in patients with bicuspid aortic valve (BAV). In BAV replacement, surgery of the AA is indicated in the case if AA diameter exceeds 45 mm. Aortic valve replacement combined with an AA intervention is associated with increased risk of complications. The feasibility of the reduction ascending aortoplasty for correction of the dilated AA remains disputable.Aim: To analyze the results of BAV surgical replacement with simultaneous surgical correction of the borderline AA dilatation (45-50 mm) by the reduction aortoplasty (RAP) or supracoronary AA replacement (SPR).Materials and methods: This single center prospective non-randomized study included 53 patients with significant BAV stenosis and AA dilatation (45-50 mm), divided into 2 groups: BAV surgical replacement combined with RAP AA replacement (group 1, 36 patients) and BAV replacement with SPR (group 2, 17 patients). There were no significant differences between the patients of the two groups in their characteristics of the underlying disease, complications and comorbidities.Results: Hospital mortality was 0%. No between-group differences in the early postoperative course were found. At later term, 44 (81.5%) patients were assessed; median (dispersion) of the follow-up was 36 (25; 50) months. Two patients from the group 2 died during the follow-up. The long-term survival was better in the group 1 (p = 0.028). No differences in the combined adverse event rate were observed between the groups (p = 0.633). The median (dispersion) of the AA absolute increment and the rate of dilatation after RAP were 1.0 (0.0; 3.0) mm and 0.24 (0.00; 0.95) mm/year, respectively. The predictor of AA increment rate ≥ 2 mm/year was the baseline blood pressure level (odds ratio 1.321, 95% confidence interval 1.050-1.662; p=0.017). The threshold preoperative blood pressure value for the increased risk of the long-term AA expansion rate was 138 mmHg.Conclusion: The efficacy and safety of RAP and SRP combined with BAV replacement in AA borderline dilatation are similar. Combined BAV surgery and RAP is effective and safe in patients with systolic blood pressure level ≤ 135 mmHg. Combined BAV replacement with SRP seems reasonable in patients with arterial hypertension.

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“…In general, surgery with concomitant cardiovascular procedures especially involving the aortic valv 4 borderline dilated distal ascending aortae with a felt or prosthetic graft to prevent dilation over the long term. Some reports have indicated that wrapping effectively preserves dilated ascending aortae [2][3][4]. However, we recently experienced a need to re-operate on a replaced distal ascending aorta of a male patient that had become dilated despite being wrapped with a prosthetic graft (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Root Reconstruction with Total Replacement of Ascending Aorta Using Hypothermic Circulatory Arrest and Selective Cerebral Perfusion for Moderately Dilated Distal Ascending Aorta

Yamashiro¹,

Arakaki²,

Kise³

et al. 2013

WJCS

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Objective: We have occasionally encountered a moderately dilated distal ascending aorta while reconstructing an aortic root. We describe reconstruction of an extended root and ascending aorta using our current strategy. Patients and Methods: Between March 2011 and December 2012, 15 (11 men; mean age, 70.1 ± 7.3 years) patients underwent root reconstruction with hemi-arch replacement under hypothermic circulatory arrest with antegrade selective cerebral perfusion. The maximum diameter of the aortic root was 52.5 ± 4.4 mm. The distal ascending aorta just below innominate artery was moderately dilated to 41.7 ± 1.4 mm in diameter. Results: Operative outcomes excluding the diameter of the distal ascending aorta did not significantly differ from those of patients who had undergone root reconstruction under distal ascending aortic clamping during the same period. Postoperative computed tomography confirmed complete resection of the dilated ascending aorta in the patients, and did not develop neurological dysfunction or stroke. Conclusion: Postoperative computed tomography confirmed complete resection of dilated ascending aortae. We considered that complete resection under hypothermic circulatory arrest and selective cerebral perfusion might help to avoid repeated surgery to treat dilation of the distal ascending aorta over the long-term.

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Safe wrapping of the borderline dilated ascending aorta during aortic valve replacement

Cited by 8 publications

References 8 publications

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

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

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

Root Reconstruction with Total Replacement of Ascending Aorta Using Hypothermic Circulatory Arrest and Selective Cerebral Perfusion for Moderately Dilated Distal Ascending Aorta

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