Clinical efficacy of reduction ascending aortoplasty with wedge resection in adult patients undergoing aortic valve replacement: A single-center retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Xiaohui , GUAN Qiang , LIU Rui , SUN Hansong , FENG Jun ,  WANG Liqing

Department of Adult Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

WANG Liqing, Email: wltsmd@sohu.com

Keywords：

Aortic valve replacement; ascending aortic angioplasty; ascending aorta dilatation; wedge resection

DOI：

10.7507/1007-4848.202012098

Video：

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Objective To assess mid-term outcomes of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR).Methods We retrospecctively analyzed clinical data of 30 adult patients with aortic valve diseases and ascending aortic dilatation in Fuwai Hospital from 2010 to 2019. There were 20 males and 10 females with an age of 38-72 (55.73±9.95) years. All patients received AVR+RAA using the wedge resection technique. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively.Results There was no perioperative death. The mean preoperative and postoperative AAD in all patients were 48.23±3.69 mm and 37.60±5.02 mm, respectively. And the mean AAD of follow-up was 40.53±4.65 mm. There was a statistical difference in AAD between preoperation and postoperation, postoperation and final follow-up, preoperation and final follow-up. The median follow-up time was 28.50 (12-114) months. The median rate of increase in AAD postoperatively was 0.76 mm per year. And the rate of increase was ≥3 mm per year in 5 patients, while ≥5 mm per year in 4 patients with indications for reoperation. Conclusion Mid-term outcomes of RAA in adult patients undergoing aortic valve replacement using the wedge resection technique are satisfying and encouraging. However, some patients still need surgical re-intervention.

Citation： ZHOU Xiaohui, GUAN Qiang, LIU Rui, SUN Hansong, FENG Jun, WANG Liqing. Clinical efficacy of reduction ascending aortoplasty with wedge resection in adult patients undergoing aortic valve replacement: A single-center retrospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1631-1636. doi: 10.7507/1007-4848.202012098 Copy

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2.	Polvani G, Barili F, Dainese L, et al. Reduction ascending aortoplasty: Midterm follow-up and predictors of redilatation. Ann Thorac Surg, 2006, 82(2): 586-591.
3.	魏波. 主动脉瓣置换术后升主动脉事件临床分析. 中华实用诊断与治疗杂志, 2013, 27(8): 777-778.
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6.	Mattens E, Engels P, Hamerlijnck R, et al. Gelseal versus Gelweave dacron prosthetic grafts in the descending thoracic aorta: A two-year computed tomography scan follow-up study. Cardiovasc Surg, 1999, 7(4): 432-435.
7.	Takami Y, Tajima K, Kato W, et al. Long-term size follow-up of knitted Dacron grafts (Gelseal^TM) used in the ascending aorta. Interact Cardiovasc Thorac Surg, 2012, 14(5): 529-531.
8.	张岩, 赵伟, 潘世伟, 等. 升主动脉成形术的早中期临床结果分析. 中国胸心血管外科临床杂志, 2014, 21(4): 457-460.
9.	Liu S, Shi Y, Liu R, et al. Early Prognosis of reduction ascending aortoplasty in patients with aortic valve disease: A single center's experience. Ann Thorac Surg, 2017, 103(2): 511-516.
10.	秦卫, 陈鑫, 黄福华. 二叶式主动脉瓣合并升主动脉扩张的外科治疗: 升主动脉置换还是成形? 中国胸心血管外科临床杂志, 2015, 22(11): 1016-1021.
11.	Robicsek F, Cook JW, Reames MK, et al. Size reduction ascending aortoplasty: Is it dead or alive? J Thorac Cardiovasc Surg, 2004, 128(4): 562-570.
12.	Tappainer E, Fiorani V, Nocchi A, et al. Safe wrapping of the borderline dilated ascending aorta during aortic valve replacement. J Cardiothorac Surg, 2007, 2: 15.
13.	Gaeta R, Savasta M, Tancredi F, et al. Resection and end-to-end anastomosis for ascending aortic aneurysm: Surgical technique. Minerva Chir, 2009, 64(6): 665-668.
14.	Thanassoulis G, Yip JW, Filion K, et al. Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves. Nat Clin Pract Cardiovasc Med, 2008, 5(12): 821-828.
15.	Hannuksela M, Lundqvist S, Carlberg B. Thoracic aorta—Dilated or not? Scand Cardiovasc J, 2006, 40(3): 175-178.
16.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
17.	Patel HJ, Deeb GM. Ascending and arch aorta: Pathology, natural history, and treatment. Circulation, 2008, 118(2): 188-195.
18.	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要. 中国循环杂志, 2020, 35(9): 833-854.
19.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): e57-e185.
20.	Nistri S, Sorbo MD, Marin M, et al. Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart, 1999, 82(1): 19-22.
21.	朱江, 李卓东, 谈梦伟, 等. 两种术式治疗主动脉瓣病变伴升主动脉扩张的疗效分析. 中国体外循环杂志, 2017, 15(3): 153-158.
22.	Agnese V, Pasta S, Michelena HI, et al. Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up. J Mol Cell Cardiol, 2019, 135: 31-39.

1. 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.
2. Polvani G, Barili F, Dainese L, et al. Reduction ascending aortoplasty: Midterm follow-up and predictors of redilatation. Ann Thorac Surg, 2006, 82(2): 586-591.
3. 魏波. 主动脉瓣置换术后升主动脉事件临床分析. 中华实用诊断与治疗杂志, 2013, 27(8): 777-778.
4. Spadaccio C, Rainer A, Barbato R, et al. The long-term follow-up of large-diameter Dacron^® vascular grafts in surgical practice: A review. J Cardiovasc Surg (Torino), 2019, 60(4): 501-513.
5. Spadaccio C, Nappi F, Al-Attar N, et al. Old myths, new concerns: The long-term effects of ascending aorta replacement with dacron grafts. Not all that glitters is gold. J Cardiovasc Transl Res, 2016, 9(4): 334-342.
6. Mattens E, Engels P, Hamerlijnck R, et al. Gelseal versus Gelweave dacron prosthetic grafts in the descending thoracic aorta: A two-year computed tomography scan follow-up study. Cardiovasc Surg, 1999, 7(4): 432-435.
7. Takami Y, Tajima K, Kato W, et al. Long-term size follow-up of knitted Dacron grafts (Gelseal^TM) used in the ascending aorta. Interact Cardiovasc Thorac Surg, 2012, 14(5): 529-531.
8. 张岩, 赵伟, 潘世伟, 等. 升主动脉成形术的早中期临床结果分析. 中国胸心血管外科临床杂志, 2014, 21(4): 457-460.
9. Liu S, Shi Y, Liu R, et al. Early Prognosis of reduction ascending aortoplasty in patients with aortic valve disease: A single center's experience. Ann Thorac Surg, 2017, 103(2): 511-516.
10. 秦卫, 陈鑫, 黄福华. 二叶式主动脉瓣合并升主动脉扩张的外科治疗: 升主动脉置换还是成形? 中国胸心血管外科临床杂志, 2015, 22(11): 1016-1021.
11. Robicsek F, Cook JW, Reames MK, et al. Size reduction ascending aortoplasty: Is it dead or alive? J Thorac Cardiovasc Surg, 2004, 128(4): 562-570.
12. Tappainer E, Fiorani V, Nocchi A, et al. Safe wrapping of the borderline dilated ascending aorta during aortic valve replacement. J Cardiothorac Surg, 2007, 2: 15.
13. Gaeta R, Savasta M, Tancredi F, et al. Resection and end-to-end anastomosis for ascending aortic aneurysm: Surgical technique. Minerva Chir, 2009, 64(6): 665-668.
14. Thanassoulis G, Yip JW, Filion K, et al. Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves. Nat Clin Pract Cardiovasc Med, 2008, 5(12): 821-828.
15. Hannuksela M, Lundqvist S, Carlberg B. Thoracic aorta—Dilated or not? Scand Cardiovasc J, 2006, 40(3): 175-178.
16. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
17. Patel HJ, Deeb GM. Ascending and arch aorta: Pathology, natural history, and treatment. Circulation, 2008, 118(2): 188-195.
18. 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要. 中国循环杂志, 2020, 35(9): 833-854.
19. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): e57-e185.
20. Nistri S, Sorbo MD, Marin M, et al. Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart, 1999, 82(1): 19-22.
21. 朱江, 李卓东, 谈梦伟, 等. 两种术式治疗主动脉瓣病变伴升主动脉扩张的疗效分析. 中国体外循环杂志, 2017, 15(3): 153-158.
22. Agnese V, Pasta S, Michelena HI, et al. Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up. J Mol Cell Cardiol, 2019, 135: 31-39.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of reduction ascending aortoplasty with wedge resection in adult patients undergoing aortic valve replacement: A single-center retrospective study

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