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Eur J Cardiothorac Surg 2007;31:614-617. doi:10.1016/j.ejcts.2007.01.028
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

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

Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Düsseldorf, Germany

Received 12 October 2006; received in revised form 31 December 2006; accepted 4 January 2007.

^_* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Moorenstrasse 5, D-40225 Duesseldorf, Germany. Tel.: +49 211 8118331; fax: +49 211 8118333. (Email: litmathe{at}med.uni-duesseldorf.de).

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 ± 9 mm down to 40.51 ± 6.2 mm (CT), p < 0.002; 54.1 ± 6.7 mm preoperatively down to 38.7 ± 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.

Key Words: Aortic surgery • External reinforcement • Ectasia

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