Mid- and long-term clinical efficacy of ascending aortic wrapping in adult patients undergoing aortic valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOU Xiaohui , SUN Hansong , WANG Shuiyun , GUO Shaoxian ,  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: wltsmd@sohu.com; WANG Liqing, Email: tempzhou@163.com

Keywords：

Aortic valve replacement; ascending aortoplasty; ascending aortic dilatation; aortic wrapping

DOI：

10.7507/1007-4848.202305010

Video：

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Objective To assess mid− and long−term outcomes of ascending aortic wrapping (AAW) in adult patients undergoing aortic valve replacement (AVR). Methods We retrospecctively analyzed clinical data of adult patients who underwent AVR and AAW in Fuwai Hospital from January 2010 to August 2019. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results A total of 33 patients were enrolled, including 23 males and 10 females aged 22−73 (51.06±12.61) years. There was no perioperative death. The mean preoperative, postoperative and follow−up AAD of the patients were 46.06±3.54 mm, 34.55±5.17 mm, and 37.12±5.64 mm, respectively. The median follow−up time was 38.20 (18.80−140.30) months. The median increase rate of diameter was 0.63 (−0.11, 1.36) mm per year after the surgery. The increase rate was>5 mm per year in 1 patient, and>3 mm in another one. Conclusion Mid−term outcomes of AAW in adult patients undergoing AVR are satisfied and encouraging.

1.	ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease Representative Members, Hiratzka LF, Creager MA, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: A statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2016, 151(4): 959-966.
2.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 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 Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
3.	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.
4.	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.
5.	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.
6.	Bauer M, Pasic M, Schaffarzyk R, et al. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg, 2002, 73(3): 720-723.
7.	Guo MH, Appoo JJ, Saczkowski R, et al. Association of mortality and acute aortic events with ascending aortic aneurysm: A Systematic review and meta-analysis. JAMA Netw Open, 2018, 1(4): e181281.
8.	周晓辉, 关强, 刘睿, 等. 斜切口楔形切除法升主动脉成形术临床效果的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(12): 1631-1636.
9.	周晓辉, 关强, 刘睿, 等. 主动脉瓣置换术+升主动脉成形术后升主动脉直径变化及中远期临床结果分析. 中国胸心血管外科临床杂志, 2023, 30(3): 381-388.
10.	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.
11.	Hannuksela M, Lundqvist S, Carlberg B. Thoracic aorta: Dilated or not?. Scand Cardiovasc J, 2006, 40(3): 175-178.
12.	Patel HJ, Deeb GM. Ascending and arch aorta: pathology, natural history, and treatment. Circulation, 2008, 118(2): 188-195.
13.	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.
14.	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.
15.	Michelena HI, Della Corte A, Evangelista A, et al. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg, 2021, 162(3): e383-e414.
16.	Agnese V, Pasta S, Michelena HI, et al. Corrigendum to 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.
17.	Coselli JS, Green SY. A brief history of aortic surgery: Insight into distal aortic repair. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S123-S125.
18.	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): S488-S497.
19.	Robicsek F, Dougherty HK, Mullen DC. External grafting of aortic aneurysms. J Thorac Cardiovasc Surg, 1971, 61(1): 131-134.
20.	Robicsek F, Thubrikar MJ. Hemodynamic considerations regarding the mechanism and prevention of aortic dissection. Ann Thorac Surg, 1994, 58(4): 1247-1253.
21.	Narayan P, Doddamane AN, Bryan AJ. Moderately dilated ascending aorta: The right wrap?. J Card Surg, 2022, 37(4): 927-929.
22.	Plonek T, Rylski B, Dumanski A, et al. Biomechanical analysis of wrapping of the moderately dilated ascending aorta. J Cardiothorac Surg, 2015, 10: 106.
23.	Verbrugghe P, Verbeken E, Pepper J, et al. External aortic root support: A histological and mechanical study in sheep. Interact Cardiovasc Thorac Surg, 2013, 17(2): 334-339.
24.	Tanabe T, Kubo Y, Hashimoto M, et al. Wall reinforcement with highly porous Dacron mesh in aortic surgery. Ann Surg, 1980, 191(4): 452-455.
25.	Cohen O, Odim J, De la Zerda D, et al. Long-term experience of girdling the ascending aorta with Dacron mesh as definitive treatment for aneurysmal dilation. Ann Thorac Surg, 2007, 83(2): S780-S784.
26.	Plonek T. A meta analysis and systematic review of wrapping of the ascending aorta. J Card Surg, 2014, 29(6): 809-815.
27.	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.
28.	Kim HH, Lee S, Lee SH, et al. The long-term fate of ascending aorta aneurysm after wrapping versus replacement. J Thorac Cardiovasc Surg, 2022, 164(2): 463-474.
29.	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.
30.	Ehrlich T, Federspiel JM, Bohle RM, et al. Severe aortic wall degeneration after aortic wrapping. Eur J Cardiothorac Surg, 2021, 60(2): 425-427.
31.	Suematsu Y, Inoue T, Nishi S, et al. Stepwise external wrapping procedure for type A intramural hematoma. J Thorac Cardiovasc Surg, 2022, 164(1): 31-38.
32.	Vento V, Multon S, Ramadan R, et al. Outcomes of urgent aortic wrapping for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2022, 164(5): 1412-1420.
33.	Giudici F, Qian Y, O'Rourke M, et al. Simulation of reduction of proximal aortic stiffness by an elastic wrap and effects on pulse pressure. Annu Int Conf IEEE Eng Med Biol Soc, 2012, 2012: 657-660.
34.	Van Hoof L, Verbrugghe P, Verbeken E, et al. Support of the aortic wall: A histological study in sheep comparing a macroporous mesh with low-porosity vascular graft of the same polyethylene terephthalate material. Interact Cardiovasc Thorac Surg, 2017, 25(1): 89-95.
35.	Prapas S, Katsavrias K, Di Mauro M, et al. Wrapping of the moderately dilated ascending aorta by fresh autologous pericardium. J Card Surg, 2022, 37(4): 921-926.
36.	张金萍, 江勇, 吴伟春, 等. 主动脉瓣机械瓣置换术后远期升主动脉内径变化随访研究. 中国循环杂志, 2016, 31(3): 267-271.
37.	Hou X, Zhang F, Ye Z, et al. The burden of aortic aneurysm in China from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. BMC Public Health, 2022, 22(1): 782.
38.	Rueda-Ochoa OL, Bons LR, Zhu F, et al. Thoracic aortic diameter and cardiovascular events and mortality among women and men. Radiology, 2022, 304(1): 208-215.
39.	Wu J, Zafar MA, Liu Y, et al. Fate of the unoperated ascending thoracic aortic aneurysm: Three-decade experience from the Aortic Institute at Yale University. Eur Heart J, 2023, ehad148.
40.	Gao J, Cao H, Hu G, et al. The mechanism and therapy of aortic aneurysms. Signal Transduct Target Ther, 2023, 8(1): 55.
41.	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.
42.	Takami Y, Tajima K, Kato W, et al. Long-term size follow-up of knitted Dacron grafts (Gelseal™) used in the ascending aorta. Interact Cardiovasc Thorac Surg, 2012, 14(5): 529-531.
43.	Etz CD, Homann T, Silovitz D, et al. Vascular graft replacement of the ascending and descending aorta: Do Dacron grafts grow?. Ann Thorac Surg, 2007, 84(4): 1206-1212.
44.	Spadaccio C, Rainer A, Barbato R, et al. The long-term follow-up of large-diameter Dacron(R) vascular grafts in surgical practice: A review. J Cardiovasc Surg (Torino), 2019, 60(4): 501-513.
45.	中国医药教育协会心脏外科分会及中国医药生物技术协会心血管外科技术, 与工程分会主动脉术式专家共识编写组. 主动脉术式中国专家共识——升主动脉包裹术. 中华胸心血管外科杂志, 2021, 37(10): 577-578.

1. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease Representative Members, Hiratzka LF, Creager MA, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: A statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2016, 151(4): 959-966.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 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 Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
3. 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.
4. 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.
5. 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.
6. Bauer M, Pasic M, Schaffarzyk R, et al. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg, 2002, 73(3): 720-723.
7. Guo MH, Appoo JJ, Saczkowski R, et al. Association of mortality and acute aortic events with ascending aortic aneurysm: A Systematic review and meta-analysis. JAMA Netw Open, 2018, 1(4): e181281.
8. 周晓辉, 关强, 刘睿, 等. 斜切口楔形切除法升主动脉成形术临床效果的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(12): 1631-1636.
9. 周晓辉, 关强, 刘睿, 等. 主动脉瓣置换术+升主动脉成形术后升主动脉直径变化及中远期临床结果分析. 中国胸心血管外科临床杂志, 2023, 30(3): 381-388.
10. 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.
11. Hannuksela M, Lundqvist S, Carlberg B. Thoracic aorta: Dilated or not?. Scand Cardiovasc J, 2006, 40(3): 175-178.
12. Patel HJ, Deeb GM. Ascending and arch aorta: pathology, natural history, and treatment. Circulation, 2008, 118(2): 188-195.
13. 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.
14. 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.
15. Michelena HI, Della Corte A, Evangelista A, et al. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg, 2021, 162(3): e383-e414.
16. Agnese V, Pasta S, Michelena HI, et al. Corrigendum to 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.
17. Coselli JS, Green SY. A brief history of aortic surgery: Insight into distal aortic repair. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S123-S125.
18. 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): S488-S497.
19. Robicsek F, Dougherty HK, Mullen DC. External grafting of aortic aneurysms. J Thorac Cardiovasc Surg, 1971, 61(1): 131-134.
20. Robicsek F, Thubrikar MJ. Hemodynamic considerations regarding the mechanism and prevention of aortic dissection. Ann Thorac Surg, 1994, 58(4): 1247-1253.
21. Narayan P, Doddamane AN, Bryan AJ. Moderately dilated ascending aorta: The right wrap?. J Card Surg, 2022, 37(4): 927-929.
22. Plonek T, Rylski B, Dumanski A, et al. Biomechanical analysis of wrapping of the moderately dilated ascending aorta. J Cardiothorac Surg, 2015, 10: 106.
23. Verbrugghe P, Verbeken E, Pepper J, et al. External aortic root support: A histological and mechanical study in sheep. Interact Cardiovasc Thorac Surg, 2013, 17(2): 334-339.
24. Tanabe T, Kubo Y, Hashimoto M, et al. Wall reinforcement with highly porous Dacron mesh in aortic surgery. Ann Surg, 1980, 191(4): 452-455.
25. Cohen O, Odim J, De la Zerda D, et al. Long-term experience of girdling the ascending aorta with Dacron mesh as definitive treatment for aneurysmal dilation. Ann Thorac Surg, 2007, 83(2): S780-S784.
26. Plonek T. A meta analysis and systematic review of wrapping of the ascending aorta. J Card Surg, 2014, 29(6): 809-815.
27. 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.
28. Kim HH, Lee S, Lee SH, et al. The long-term fate of ascending aorta aneurysm after wrapping versus replacement. J Thorac Cardiovasc Surg, 2022, 164(2): 463-474.
29. 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.
30. Ehrlich T, Federspiel JM, Bohle RM, et al. Severe aortic wall degeneration after aortic wrapping. Eur J Cardiothorac Surg, 2021, 60(2): 425-427.
31. Suematsu Y, Inoue T, Nishi S, et al. Stepwise external wrapping procedure for type A intramural hematoma. J Thorac Cardiovasc Surg, 2022, 164(1): 31-38.
32. Vento V, Multon S, Ramadan R, et al. Outcomes of urgent aortic wrapping for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2022, 164(5): 1412-1420.
33. Giudici F, Qian Y, O'Rourke M, et al. Simulation of reduction of proximal aortic stiffness by an elastic wrap and effects on pulse pressure. Annu Int Conf IEEE Eng Med Biol Soc, 2012, 2012: 657-660.
34. Van Hoof L, Verbrugghe P, Verbeken E, et al. Support of the aortic wall: A histological study in sheep comparing a macroporous mesh with low-porosity vascular graft of the same polyethylene terephthalate material. Interact Cardiovasc Thorac Surg, 2017, 25(1): 89-95.
35. Prapas S, Katsavrias K, Di Mauro M, et al. Wrapping of the moderately dilated ascending aorta by fresh autologous pericardium. J Card Surg, 2022, 37(4): 921-926.
36. 张金萍, 江勇, 吴伟春, 等. 主动脉瓣机械瓣置换术后远期升主动脉内径变化随访研究. 中国循环杂志, 2016, 31(3): 267-271.
37. Hou X, Zhang F, Ye Z, et al. The burden of aortic aneurysm in China from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. BMC Public Health, 2022, 22(1): 782.
38. Rueda-Ochoa OL, Bons LR, Zhu F, et al. Thoracic aortic diameter and cardiovascular events and mortality among women and men. Radiology, 2022, 304(1): 208-215.
39. Wu J, Zafar MA, Liu Y, et al. Fate of the unoperated ascending thoracic aortic aneurysm: Three-decade experience from the Aortic Institute at Yale University. Eur Heart J, 2023, ehad148.
40. Gao J, Cao H, Hu G, et al. The mechanism and therapy of aortic aneurysms. Signal Transduct Target Ther, 2023, 8(1): 55.
41. 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.
42. Takami Y, Tajima K, Kato W, et al. Long-term size follow-up of knitted Dacron grafts (Gelseal™) used in the ascending aorta. Interact Cardiovasc Thorac Surg, 2012, 14(5): 529-531.
43. Etz CD, Homann T, Silovitz D, et al. Vascular graft replacement of the ascending and descending aorta: Do Dacron grafts grow?. Ann Thorac Surg, 2007, 84(4): 1206-1212.
44. Spadaccio C, Rainer A, Barbato R, et al. The long-term follow-up of large-diameter Dacron(R) vascular grafts in surgical practice: A review. J Cardiovasc Surg (Torino), 2019, 60(4): 501-513.
45. 中国医药教育协会心脏外科分会及中国医药生物技术协会心血管外科技术, 与工程分会主动脉术式专家共识编写组. 主动脉术式中国专家共识——升主动脉包裹术. 中华胸心血管外科杂志, 2021, 37(10): 577-578.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesMid- and long-term clinical efficacy of ascending aortic wrapping in adult patients undergoing aortic valve replacement

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