Early to Mid-term Results of Modified Aortoplasty with External Wrap for Aneurysmal Dilatation of the Ascending Aorta_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIANHui ¹ , HUANGFeng ² , DINGHang ² , RENFei ² ,  HANTao ²

1. Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350001, P. R. China;
2. Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fujian Provincial Institute of Cardiovascular Disease, Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350001, P. R. China;

Corresponding author：

HANTao, Email: fjsxxwk@163.com

Keywords：

Aortic disease; Aneurysmal dilatation; Aortoplasty with external wrap

DOI：

10.7507/1007-4848.20140210

Video：

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Objective To summarize clinical experience and early to mid-term results of modified aortoplasty with external wrap for aneurysmal dilatation of the ascending aorta with or without heart valve disease. Methods Clinical data of 27 patients with aneurysmal dilatation of the ascending aorta who underwent modified aortoplasty with external wrap in Department of Cardiovascular Surgery, Fujian Provincial Hospital from January to October 2003 were retrospectively analyzed. There were 19 male and 8 female patients with their age of 35-71 (57±9)years and body weight of 42-90 (59±11)kg.There were 23 patients with aortic valve disease including 3 patients with bicuspid aortic valve. There were 4 patients in New York Heart Association function class Ⅰ, 9 patients in class Ⅱ, 12 patients in class Ⅲ, and 2 patients in class Ⅳ. Preoperative ascending aortic diameter (AAOD)was 40.0-59.1 (46.4±4.8)mm, left ventricular end-diastolic diameter was 42.5-70.7 (56.9±8.3)mm, and left ventricular ejection fraction (LVEF)was 57.7%±8.0%. Patients were followed up with echocardiography to examine changes of AAOD and left ventricle. Results Cardiopulmonary bypass (CPB)time was 121.2±52.6 minutes, and aortic cross-clamping time was 70.6±29.7 minutes. Two patients received modified aortoplasty without CPB. There was no in-hospital death.Among the 25 patients who received modified aortoplasty under CPB, 1 patient had cerebral infarction and another patient had hypotension and arrhythmia postoperatively.Postoperative AAOD (36.3±3.4 mm)was significantly smaller than preoperative AAOD (46.4±4.8 mm, t=1.675, P < 0.05). Twenty-four patients were followed up from 1.0 to 120.5 months (average, 35.5 months). During follow-up, no cardiac-related death or reoperation was found. Two patients died of pneumonia, and another 2 patients died of cerebral hemorrhage. One patient had upper gastrointestinal bleeding. Aneurysmal dilatation of the ascending aorta recurred in 1 patient 3 years after discharge with AAOD of 49.9 mm. AAOD at 1 year (40.3±4.3 mm)and 3 years (40.3±5.6 mm)after discharge were significantly smaller than preoperative and postoperative AAOD (P < 0.05). Conclusion Modified aortoplasty with external wrap is a good surgical procedure for aneurysmal dilatation of the ascending aorta with or without valve disease, and early to mid-term results are satisfactory.

Citation： NIANHui, HUANGFeng, DINGHang, RENFei, HANTao. Early to Mid-term Results of Modified Aortoplasty with External Wrap for Aneurysmal Dilatation of the Ascending Aorta. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 730-734. doi: 10.7507/1007-4848.20140210 Copy

1.	Mueller XM, Tevaearai HT, Genton CY, et al. Drawback of aorto-plasty for aneurysm of the ascending aorta associated with aortic valve disease. Ann Thorac Surg, 1997, 63(3):762-767.
2.	Robicsek F, Cook JW, Reames MK Sr, et al. Size reduction ascending aortoplasty:Is it dead or alive? J Thorac Cardiovasc Surg, 2004, 128(4):562-570.
3.	Hagl C, Strauch JT, Spielvogel D, et al. Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival? Ann Thorac Surg, 2003, 76(3):698-703.
4.	Roman MJ, Devereux RB, Kramer-Fox R, et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol, 1989, 64(8):507-512.
5.	Martin C, Sun W, Primiano C, et al. Age-dependent ascending aorta mechanics assessed through multiphase CT. Ann Biomed Eng, 2013, 41(12):2565-2574.
6.	Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? Thorac Cardiovasc Surg, 1997, 113(3):476-491.
7.	Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? Thorac Cardiovasc Surg, 2004, 128(5):677-683.
8.	Mckellar SH, Michelena HI, Li Z, et al. Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves. Am J Cardiol, 2010, 106(11):1626-1633.
9.	白雪, 余辉, 袁清华, 等. 358例主动脉夹层发病危险因素、临床特点及预后分析.新疆医科大学学报, 2013, 36(10):1473-1475, 1479.
10.	Akgun S, Atalan N, Fazlioğullari O, et al. Aortic root aneurysm after off-pump reduction aortoplasty. Ann Thorac Surg, 2010, 90(5):e69-e70.
11.	兰怀, 王辉山, 韩宏光, 等. Bentall手术治疗马方综合征的疗效分析.中国胸心血管外科临床杂志, 2013, 20(1):100-102.
12.	贺继刚, 陈智豫, 王戈楠, 等.胸主动脉真性动脉瘤的外科治疗.中国胸心血管外科临床杂志, 2012, 19(4):438-439.
13.	张怀军, 孙立忠, 常谦, 等. 32例Wheat手术临床分析.中华胸心血管外科杂志, 2004, 20(3):129-130.
14.	David TE, Feindel CM, Webb GD, et al. Aortic valve preservation in patients with aortic root aneurysm:results of the reimplantation technique. Ann Thorac Surg, 2007, 83(2):S732-S790.
15.	陈伟丹, 常谦, 李守军, 等.保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的疗效分析.中国胸心血管外科临床杂志, 2012, 19(5):498-501.
16.	Blehm A, Schurr P, Sorokin VA, et al. Comparison of different surgical techniques in 112 consecutive patients with aortic root operations:when should the valve be spared? J Heart Valve Dis, 2014, 23(1):9-16.
17.	许建屏, 郭宏伟, 史艺, 等.主动脉成形术治疗主动脉瓣病变伴升主动脉扩张的疗效分析.中华外科杂志, 2005, 43(10):638-640.
18.	Etz CD, von Aspern K, Girrbach FF, et al. Long-term survival after composite mechanical aortic root replacement:a consecutive series of 448 cases. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl):S41-S47.
19.	Gill M, Dunning J. Is reduction aortoplasty(with or without external wrap)an acceptable alternative to replacement of the dilated ascending aorta? Interact Cardiovasc Thorac Surg, 2009, 9(4):693-697.
20.	Polvani G, Barili F, Dainese L, et al. Reduction ascending aorto-plasty:midterm Follow-Up and predictors of redilatation. Ann Thorac Surg, 2006, 82(2):586-591.
21.	Kallenbach K, Kojic D, Oezsoez M, et al. Treatment of ascending aortic aneurysms using different surgical techniques:a single-centre experience with 548 patients. Eur J Cardiothorac Surg, 2013, 44(2):337-345.
22.	Tappainer E, Fiorani V, Nocchi A, et al. Safe wrapping of the borderline dilated ascending dilated ascending aorta during aortic valve replacement. Cardiothorac Surg, 2007, 2:15.
23.	Barnett MG, Fiore AC, Vaca KJ, et al. Tailoring aortoplasty for repair of fusiform ascending aortic aneurysms. Ann Thorac Surg, 1995, 59(2):451-497.
24.	Bauer M, Pasic M, Schaffarzyk R, et al. Reduction aortoplasty for aneurismal dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg, 2002, 73(3):720-724.
25.	Kamada T, Imanaka K, Ohuchi H, et al. Mid-term results of aortoplasty for dilated ascending aorta associated with aortic valve disease. Ann Thorac Cardiovasc Surg, 2003, 9(4):253-256.
26.	Bauer M, Grauhan O, Hetzer R. Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta. Ann Thorac Surg, 2003, 75(2):583-584.

1. Mueller XM, Tevaearai HT, Genton CY, et al. Drawback of aorto-plasty for aneurysm of the ascending aorta associated with aortic valve disease. Ann Thorac Surg, 1997, 63(3):762-767.
2. Robicsek F, Cook JW, Reames MK Sr, et al. Size reduction ascending aortoplasty:Is it dead or alive? J Thorac Cardiovasc Surg, 2004, 128(4):562-570.
3. Hagl C, Strauch JT, Spielvogel D, et al. Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival? Ann Thorac Surg, 2003, 76(3):698-703.
4. Roman MJ, Devereux RB, Kramer-Fox R, et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol, 1989, 64(8):507-512.
5. Martin C, Sun W, Primiano C, et al. Age-dependent ascending aorta mechanics assessed through multiphase CT. Ann Biomed Eng, 2013, 41(12):2565-2574.
6. Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? Thorac Cardiovasc Surg, 1997, 113(3):476-491.
7. Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? Thorac Cardiovasc Surg, 2004, 128(5):677-683.
8. Mckellar SH, Michelena HI, Li Z, et al. Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves. Am J Cardiol, 2010, 106(11):1626-1633.
9. 白雪, 余辉, 袁清华, 等. 358例主动脉夹层发病危险因素、临床特点及预后分析.新疆医科大学学报, 2013, 36(10):1473-1475, 1479.
10. Akgun S, Atalan N, Fazlioğullari O, et al. Aortic root aneurysm after off-pump reduction aortoplasty. Ann Thorac Surg, 2010, 90(5):e69-e70.
11. 兰怀, 王辉山, 韩宏光, 等. Bentall手术治疗马方综合征的疗效分析.中国胸心血管外科临床杂志, 2013, 20(1):100-102.
12. 贺继刚, 陈智豫, 王戈楠, 等.胸主动脉真性动脉瘤的外科治疗.中国胸心血管外科临床杂志, 2012, 19(4):438-439.
13. 张怀军, 孙立忠, 常谦, 等. 32例Wheat手术临床分析.中华胸心血管外科杂志, 2004, 20(3):129-130.
14. David TE, Feindel CM, Webb GD, et al. Aortic valve preservation in patients with aortic root aneurysm:results of the reimplantation technique. Ann Thorac Surg, 2007, 83(2):S732-S790.
15. 陈伟丹, 常谦, 李守军, 等.保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的疗效分析.中国胸心血管外科临床杂志, 2012, 19(5):498-501.
16. Blehm A, Schurr P, Sorokin VA, et al. Comparison of different surgical techniques in 112 consecutive patients with aortic root operations:when should the valve be spared? J Heart Valve Dis, 2014, 23(1):9-16.
17. 许建屏, 郭宏伟, 史艺, 等.主动脉成形术治疗主动脉瓣病变伴升主动脉扩张的疗效分析.中华外科杂志, 2005, 43(10):638-640.
18. Etz CD, von Aspern K, Girrbach FF, et al. Long-term survival after composite mechanical aortic root replacement:a consecutive series of 448 cases. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl):S41-S47.
19. Gill M, Dunning J. Is reduction aortoplasty(with or without external wrap)an acceptable alternative to replacement of the dilated ascending aorta? Interact Cardiovasc Thorac Surg, 2009, 9(4):693-697.
20. Polvani G, Barili F, Dainese L, et al. Reduction ascending aorto-plasty:midterm Follow-Up and predictors of redilatation. Ann Thorac Surg, 2006, 82(2):586-591.
21. Kallenbach K, Kojic D, Oezsoez M, et al. Treatment of ascending aortic aneurysms using different surgical techniques:a single-centre experience with 548 patients. Eur J Cardiothorac Surg, 2013, 44(2):337-345.
22. Tappainer E, Fiorani V, Nocchi A, et al. Safe wrapping of the borderline dilated ascending dilated ascending aorta during aortic valve replacement. Cardiothorac Surg, 2007, 2:15.
23. Barnett MG, Fiore AC, Vaca KJ, et al. Tailoring aortoplasty for repair of fusiform ascending aortic aneurysms. Ann Thorac Surg, 1995, 59(2):451-497.
24. Bauer M, Pasic M, Schaffarzyk R, et al. Reduction aortoplasty for aneurismal dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg, 2002, 73(3):720-724.
25. Kamada T, Imanaka K, Ohuchi H, et al. Mid-term results of aortoplasty for dilated ascending aorta associated with aortic valve disease. Ann Thorac Cardiovasc Surg, 2003, 9(4):253-256.
26. Bauer M, Grauhan O, Hetzer R. Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta. Ann Thorac Surg, 2003, 75(2):583-584.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early to Mid-term Results of Modified Aortoplasty with External Wrap for Aneurysmal Dilatation of the Ascending Aorta

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