Is it only a mechanical matter? Histologic modifications of the aorta underlying external banding

Neri, Eugénio; Massetti, Massimo; Tanganelli, Piero; Capannini, Gianni; Carone, Enrico; Tripodi, Alberto; Tucci, Enrico; Sassi, Carlo

doi:10.1016/s0022-5223(99)70111-x

Cited by 47 publications

(52 citation statements)

References 5 publications

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“…However, no prospective studies have been carried out to compare its results with those of other techniques. On the other hand, some cases of rupture of the remaining aortic wall have been reported, in spite of the external synthetic reinforcement (14). The incidence of this complication was 1.1% in a survey carried out by Robicsek in 2004 (15).…”

Section: Conservative Surgical Optionsmentioning

confidence: 99%

“…Neri et al carried out an histologic examination of aortic tissue specimens retrieved from two patients during a reoperation performed years after they had undergone supported reduction aortoplasty, and compared them with the samples retrieved during the first operation (14). These authors described that the reinforced aorta was significantly thinner, with a sclerotic microstructure in which layers were no longer present.…”

Section: Structural or Histologic Effectsmentioning

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: Conservative Surgical Optionsmentioning

confidence: 99%

Section: Structural or Histologic Effectsmentioning

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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“…An adequate anchoring of the tubular graft is important to prevent complications. Neri and colleagues (Neri et al, 1999) reported on 2 patients who developed false aneurysm of the ascending aorta after 7 and 11 years, respectively. Histological examination of the aortic wall underlying the reinforcement cuff revealed extensive wall degeneration.…”

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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“…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%

“…The interruption of nutrition of the vasa vasorum from the tunica media of the aorta, the chronic inflammatory response to the presence of foreign body or simply the compression of the aortic wall by opposing forces (external wrapping and aortic pressure) could interfere with the metabolism of the aortic wall and lead to atrophy and sclerosis [18]. 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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Is it only a mechanical matter? Histologic modifications of the aorta underlying external banding

Cited by 47 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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