Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOU Xiaohui , GUAN Qiang , LIU Rui , SUN Hansong , SONG Yunhu , WANG Shuiyun , XU Jianping , LV Feng ,  WANG Liqing

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

Corresponding author：

ZHOU Xiaohui, Email: tempzhou@163.com; WANG Liqing, Email: wltsmd@sohu.com

Keywords：

Aortic valve replacement; reduction ascending aortoplasty; ascending aortic dilatation; sandwich technique; wrapping technique

DOI：

10.7507/1007-4848.202102030

Video：

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Objective To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR).Methods We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively.Results There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year.Conclusion Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Citation： ZHOU Xiaohui, GUAN Qiang, LIU Rui, SUN Hansong, SONG Yunhu, WANG Shuiyun, XU Jianping, LV Feng, WANG Liqing. Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 381-388. doi: 10.7507/1007-4848.202102030 Copy

1.	Carrel T, von Segesser L, Jenni R, et al. Dealing with dilated ascending aorta during aortic valve replacement: Advantages of conservative surgical approach. Eur J Cardiothorac Surg, 1991, 5(3): 137-143.
2.	Bahnson HT, Nelson AR. Cystic medial necrosis as a cause of localized aortic aneurysms amenable to surgical treatment. Ann Surg, 1956, 144(4): 519-529.
3.	Jortner R, Shahin W, Eshkol D, et al. Cardiovascular manifestations and surgery for Marfan's syndrome. Dis Chest, 1969, 56(1): 24-30.
4.	Robicsek F, Daugherty HK, Mullen DC. External grafting of aortic aneurysms. J Thorac Cardiovasc Surg, 1971, 61(1): 131-134.
5.	Robicsek F. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: An alternative to radical resection. Ann Thorac Surg, 1982, 34(1): 92-94.
6.	Harrison LH, Heck HA. Shawl lapel aortoplasty. Ann Thorac Surg, 1996, 62(6): 1867.
7.	Baumgartner F, Omari B, Pak S, et al. Reduction aortoplasty for moderately sized ascending aortic aneurysms. J Card Surg, 1998, 13(2): 129-132.
8.	Cotrufo M, Della Corte A, De Santo LS, et al. Asymmetric medial degeneration of the ascending aorta in aortic valve disease: A pilot study of surgical management. J Heart Valve Dis, 2003, 12(2): 127-133.
9.	Nazer RI. Spiral aortoplasty for dilated ascending aorta: A new technique for high-risk patients with combined procedures. J Cardiothorac Surg, 2019, 14(1): 135.
10.	Sternik L, Zehr KJ, Schaff HV. A method of repair for asymmetric aneurysmal dilatation of the ascending aorta. Ann Thorac Surg, 2002, 73(4): 1332-1334.
11.	Viganò M, Rinaldi M, D'Armini AM, et al. Ascending aortic aneurysms treated by cuneiform resection and end-to-end anastomosis through a ministernotomy. Ann Thorac Surg, 2002, 74(5): S1789-S1791.
12.	Albes JM, Wahlers T. Valve-sparing root reduction plasty in aortic aneurysm: The "Jena" technique. Ann Thorac Surg, 2003, 75(3): 1031-1033.
13.	Ogus NT, Ciçek S, Isik O. Selective management of high risk patients with an ascending aortic dilatation during aortic valve replacement. J Cardiovasc Surg (Torino), 2002, 43(5): 609-615.
14.	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.
15.	Plonek T. A meta analysis and systematic review of wrapping of the ascending aorta. J Card Surg, 2014, 29(6): 809-815.
16.	González-Santos JM, Arnáiz-García ME. Wrapping of the ascending aorta revisited-Is there any role left for conservative treatment of ascending aortic aneurysm? J Thorac Dis, 2017, 9(Suppl 6): 488-497.
17.	李阳, 蒙炜, 张尔永. 无包裹-纵切口升主动脉成形术治疗升主动脉扩张的疗效分析. 中国修复重建外科杂志, 2012, 26(7): 819-822.
18.	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.
19.	Neri E, Massetti M, Tanganelli P, et al. Is it only a mechanical matter? Histologic modifications of the aorta underlying external banding. J Thorac Cardiovasc Surg, 1999, 118(6): 1116-1118.
20.	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.
21.	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.
22.	Juvonen T, Ergin MA, Galla JD, et al. Prospective study of the natural history of thoracic aortic aneurysms. Ann Thorac Surg, 1997, 63(6): 1533-1545.
23.	Coady MA, Rizzo JA, Goldstein LJ, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin, 1999, 17(4): 615-635.
24.	Patel HJ, Deeb GM. Ascending and arch aorta: Pathology, natural history, and treatment. Circulation, 2008, 118(2): 188-195.
25.	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.
26.	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.
27.	Li Y, Wei X, Zhao Z, et al. Prevalence and complications of bicuspid aortic valve in Chinese according to echocardiographic database. Am J Cardiol, 2017, 120(2): 287-291.
28.	Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med, 2014, 370(20): 1920-1929.
29.	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.
30.	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.
31.	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.
32.	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. Carrel T, von Segesser L, Jenni R, et al. Dealing with dilated ascending aorta during aortic valve replacement: Advantages of conservative surgical approach. Eur J Cardiothorac Surg, 1991, 5(3): 137-143.
2. Bahnson HT, Nelson AR. Cystic medial necrosis as a cause of localized aortic aneurysms amenable to surgical treatment. Ann Surg, 1956, 144(4): 519-529.
3. Jortner R, Shahin W, Eshkol D, et al. Cardiovascular manifestations and surgery for Marfan's syndrome. Dis Chest, 1969, 56(1): 24-30.
4. Robicsek F, Daugherty HK, Mullen DC. External grafting of aortic aneurysms. J Thorac Cardiovasc Surg, 1971, 61(1): 131-134.
5. Robicsek F. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: An alternative to radical resection. Ann Thorac Surg, 1982, 34(1): 92-94.
6. Harrison LH, Heck HA. Shawl lapel aortoplasty. Ann Thorac Surg, 1996, 62(6): 1867.
7. Baumgartner F, Omari B, Pak S, et al. Reduction aortoplasty for moderately sized ascending aortic aneurysms. J Card Surg, 1998, 13(2): 129-132.
8. Cotrufo M, Della Corte A, De Santo LS, et al. Asymmetric medial degeneration of the ascending aorta in aortic valve disease: A pilot study of surgical management. J Heart Valve Dis, 2003, 12(2): 127-133.
9. Nazer RI. Spiral aortoplasty for dilated ascending aorta: A new technique for high-risk patients with combined procedures. J Cardiothorac Surg, 2019, 14(1): 135.
10. Sternik L, Zehr KJ, Schaff HV. A method of repair for asymmetric aneurysmal dilatation of the ascending aorta. Ann Thorac Surg, 2002, 73(4): 1332-1334.
11. Viganò M, Rinaldi M, D'Armini AM, et al. Ascending aortic aneurysms treated by cuneiform resection and end-to-end anastomosis through a ministernotomy. Ann Thorac Surg, 2002, 74(5): S1789-S1791.
12. Albes JM, Wahlers T. Valve-sparing root reduction plasty in aortic aneurysm: The "Jena" technique. Ann Thorac Surg, 2003, 75(3): 1031-1033.
13. Ogus NT, Ciçek S, Isik O. Selective management of high risk patients with an ascending aortic dilatation during aortic valve replacement. J Cardiovasc Surg (Torino), 2002, 43(5): 609-615.
14. 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.
15. Plonek T. A meta analysis and systematic review of wrapping of the ascending aorta. J Card Surg, 2014, 29(6): 809-815.
16. González-Santos JM, Arnáiz-García ME. Wrapping of the ascending aorta revisited-Is there any role left for conservative treatment of ascending aortic aneurysm? J Thorac Dis, 2017, 9(Suppl 6): 488-497.
17. 李阳, 蒙炜, 张尔永. 无包裹-纵切口升主动脉成形术治疗升主动脉扩张的疗效分析. 中国修复重建外科杂志, 2012, 26(7): 819-822.
18. 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.
19. Neri E, Massetti M, Tanganelli P, et al. Is it only a mechanical matter? Histologic modifications of the aorta underlying external banding. J Thorac Cardiovasc Surg, 1999, 118(6): 1116-1118.
20. 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.
21. 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.
22. Juvonen T, Ergin MA, Galla JD, et al. Prospective study of the natural history of thoracic aortic aneurysms. Ann Thorac Surg, 1997, 63(6): 1533-1545.
23. Coady MA, Rizzo JA, Goldstein LJ, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin, 1999, 17(4): 615-635.
24. Patel HJ, Deeb GM. Ascending and arch aorta: Pathology, natural history, and treatment. Circulation, 2008, 118(2): 188-195.
25. 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.
26. 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.
27. Li Y, Wei X, Zhao Z, et al. Prevalence and complications of bicuspid aortic valve in Chinese according to echocardiographic database. Am J Cardiol, 2017, 120(2): 287-291.
28. Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med, 2014, 370(20): 1920-1929.
29. 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.
30. 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.
31. 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.
32. 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

Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results

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