Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery?

Abstract

Objective: Enlargement of the ascending aorta is often combined with valvular, coronary, or other cardiac diseases. Reduction aortoplasty can be an optional therapy; however, indications regarding the diameter of aorta, the history of dilatation (poststenosis, bicuspid aortic valve), or the intraoperative management (wall excision, reduction suture, external reinforcement) are not established. Methods: In a retrospective study between 1997 and 2005, we investigated 531 patients operated for aneurysm or ectasia of the ascending aorta (diameter: 45-76 mm). Of these, in 50 patients, size-reducing ascending aortoplasty was performed. External reinforcement with a non-coated dacron prosthesis was added in order to stabilize the aortic wall. Results: Aortoplasty was associated with aortic valve replacement in 47 cases (35 mechanical vs 12 biological), subvalvular myectomy in 29 cases, and CABG in 13 cases. The procedure was performed with low hospital mortality (2%) and a low postoperative morbidity. Computertomographic and echocardiographic diameters were significantly smaller after reduction (55.8 AE 9 mm down to 40.51 AE 6.2 mm (CT), p < 0.002; 54.1 AE 6.7 mm preoperatively down to 38.7 AE 7.1 mm (echocardiography), p < 0.002), with stable performance in long-term follow-up (mean follow-up time: 70 months). Conclusions: As demonstrated in this study, size reduction of the ascending aorta using aortoplasty with external reinforcement is a safe procedure with excellent long-term results. It is a therapeutic option in modern aortic surgery in patients with poststenotic dilatation of the aorta without impairment of the sinotubular junction of the aortic valve and root. #

Reduction Aortoplasty for the Ascending Aortic Aneurysm With Aortic Valve Disease - Does Bicuspid Valve Matter? -

“…1, 8 However, controversies still exist with regard to indications, techniques and long-term results of RAA. [5][6][7][8] Previous studies have demonstrated that in-hospital mortality associated with RAA and aortic valve replacement ranged from 1.5 to 11.8% and bleeding complications related to reduction suture were rare. 5-7, 14 The present study also demonstrated low operative mortality and acceptable morbidities after RAA.…”

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

“…Polvani et al [15] and Kamada et al [19] suggest that the diameter of 55 mm should be considered as limit of indication for the procedure. However, Feindt et al [16] reported good results in patients up to 65 mm diameter, who had no dilation of the sinotubular junction and the aortic arch. In this research we included patients with a diameter from 57 mm to 68 mm (mean 63.7 mm), even knowing the potential risk of late redilation since such patients had high surgical risk for ascending aortic replacement (EuroSCORE 11 to 19 ).…”

“…Polvani et al [15] reported survival of 89.3% of patients who had undergone RA after 6 years of follow-up, with 95.7% of them free of death from cardiovascular causes. Also, Feindt et al [16] achieved in 13 patients who had undergone this technique, 100% of success after 6 years. These results are consistent with other reports in the literature [10][11][12].…”

“…Usually, such procedure is indicated in elderly patients with high peroperative risk [15] and with need for reduction of time in myocardial ischemia [2.12]. There is consensus that the RA should not be used in patients with type A aortic dissection , Marfan's syndrome and cystic medial necrosis [8,15,16]. The rate of postoperative complications is reduced with the use of reduction aortoplasty, especially with regard to acute myocardial infarction, stroke and re-exploration due to bleeding [2].…”

Mid term follow up in patients with reduction ascending aortoplasty

“…This is a viable procedure which has demonstrated a number of advantages (less invasive as compared to replacement with a Dacron graft, shorter aortic clamping time, lower risk of bleeding) [6][7][8]. In addition, lower mortalities and morbidities were reported in patients with RAA [9]. The RAA remains, however, a controversial surgical option due to the potential risk of re-dilatation.…”