Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta

Bauer, Matthias; Grauhan, O.; Hetzer, Roland

doi:10.1016/s0003-4975(02)04338-2

Cited by 53 publications

(48 citation statements)

References 5 publications

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“…On the other hand, no residual or recurrent aortic pathologies or need for a new correction was recorded in the 272 patients who were only treated with AA wrapping, whereas the combined incidence of these circumstances were 2% and 3% respectively in the 450 patients with concomitant reduction through resection aortoplasty or through plication of the aortic wall. Aortic re-dilatation was observed in areas which were not reinforced or which were insufficiently reinforced, particularly in the noncoronary sinus of Valsalva, and it has been associated with a bad placement or a migration of the prosthesis (34,35). For this reason, Cohen et al have highlighted the importance of reinforcing this area with a triangular expansion of the aortic wrap, which is anchored to the ventricular-aortic junction (18).…”

Section: Long-term Resultsmentioning

confidence: 99%

“…However, this potential complication has not been described in the many series that have analyzed the clinical results, or in the autopsies of patients who died after AA wrapping (18). Bauer et al described the asymptomatic erosion of the aortic wall underlying a folded area of the external graft found in a patient re-operated because of other causes 4 years after the original operation (34). The formation of folds in the prosthesis might increase the aortic wall stress and promote the formation of a lesion caused by erosion.…”

Section: Long-term Resultsmentioning

confidence: 99%

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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: Long-term Resultsmentioning

confidence: 99%

Section: Long-term Resultsmentioning

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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“…Akgun (Akgun et al, 2010) reported an aortic root aneurysm in a patient who 7 years earlier underwent a reduction aortoplasty with external wrapping. Bauer (Bauer et al, 2003) found, in 1 patient, that the dacron wrapping had become dislocated by moving to the distal part of the ascending aorta, creating a sharp fold at the inner curve of the vessel. In this region he noted an extreme rarefaction of the aortic wall with impending rupture.…”

Section: Discussionmentioning

confidence: 99%

Alternative Surgical Management of Ascending Aorta Aneurysm

Perrotta¹,

Lentini²

2011

Aneurysmal Disease of the Thoracic and Abdominal Aorta

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“…The combination of two techniques produces reduction of stress Laplace's law) and strengthening of the aortic wall [13]. However, other authors question the need of external wrapping, including report of adverse effects, such as erosion [17] and degeneration of the arterial wall [18]. Extensive degeneration of the aortic wall was showed in two patients reoperated by Neri et al [18], due to the development of late pseudoaneurysm after reduction aortoplasty with external wrapping.…”

Section: Discussionmentioning

confidence: 99%

“…Such complications would be avoided by appropriate positioning and anchoring of the prosthesis, by avoiding the formation of bendings in the aortic wall, which resulted in areas of high mechanical stress [17].…”

Section: Discussionmentioning

confidence: 99%

Aortoplastia redutora com contenção externa associada à troca valvar aórtica em pacientes de alto risco

Haddad¹,

Fagundes²,

Pinheiro³

2009

Rev Bras Cir Cardiovasc

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Aortoplastia redutora com contenção externa associada à troca valvar aórtica em pacientes de alto riscoReduction aortoplasty with external wrapping associated with aortic valve replacement in highrisk patients Abstract Objective: To assess the midterm follow-up of reduction aortoplasty with external wrapping associated with aortic valve replacement in high risk patients.Methods: Six patients with ascending aortic aneurysm and aortic valve disease were included in this study. Four of them were male. The age ranged from 61 to 70 years (mean 65.7 years). One patient presented severe mitral valve insufficiency. All patients underwent aortic valve replacement (83.3% with aortic insufficiency and 16.7% with aortic stenosis). The inclusion criteria were: surgical aortic valve disease, ascending aortic aneurysm > 5.5 cm, EuroSCORE > 6 and age above 60 years. The ascending aortic diameter ranged from 57 to 68 mm (mean 63.7 mm). Data were analyzed by paired T test for comparison between the studied variables and P < 0.05 was considered significant.Results: All patients underwent reduction aortoplasty with external wrapping associated with aortic valve replacement. The postoperative hospital mortality and morbidity was 0% and 16.7% (atrial fibrillation), respectively. The mean ascending aortic diameter was 37.0 + 4.5mm after 6 months of follow-up (P < 0.0001, compared with the preoperative period). The actuarial survival curve after 28 months of follow-up was 100%.

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Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta

Cited by 53 publications

References 5 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?

Alternative Surgical Management of Ascending Aorta Aneurysm

Aortoplastia redutora com contenção externa associada à troca valvar aórtica em pacientes de alto risco

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