An alternate solution for the treatment of ascending aortic aneurysms: the wrapping technique

Abstract

BackgroundThe aortic Dacron wrapping technique is a surgical technique used under certain circumstances in cases of ascending aorta dilatation. Herein, we are presenting our experience on the method performed on multimorbid patients who denied major aortic surgery.MethodsWe included in our series 7 patients (5 male-2 female) with mild to moderate ascending aortic dilatation, who were operated with the wrapping technique. One patient was submitted to biological aortic valve replacement during the same procedure. The number of conventionally operated patients during the same period (2 years) was 21.ResultsMortality during the 18-months follow-up control was 0%. One patient had to be operated with biological aortic valve replacement 18 months after the initial wrapping operation, although the diameter of her ascending aorta remained stable.ConclusionsThe Dacron wrapping technique is a method that can alternatively be used in multimorbid patients with mild to moderate ascending aortic dilatation without dissecting elements and has generally good results.

A Metaanalysis and Systematic Review of Wrapping of the Ascending Aorta

“…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.…”

“…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), 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.…”

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

“…Additionally, patients with connective‐tissue diseases, including Marfan's syndrome, or acute or chronic dissection should be excluded . Wrapping of the ascending aorta is ideal for patients who have multiple co‐morbidities and for whom a prolonged operative time would significantly increase their mortality risk …”

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

“…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).…”