Reduction Ascending Aortoplasty Without External Wrap For Dilatation Of The Ascending Aorta

ObjectiveIt is controversial how to deal with an ectatic ascending aorta of from40mm to55mm in diameter in patients with the operation-needed aortic valve disease and ascending aortic dilatation. The purpose of this subject is to analyze the results of reduction ascending aortoplasty without external wrap for dilatation of the ascending aorta in patients with aortic valve disease and to compare with ascending aortic prosthetic replacement.MethodsWe reviewed these patients with ascending aortic dilatation who underwent surgical operation in our department from March2005to July2011.50patients underwent reduction ascending aortoplasty without external wrap (aortoplasty group),33patients underwent ascending aortic prosthetic replacement(replacement group). The results of surgical operations were analysed for two groups. The diameter of the ascending aorta was measured before and early after surgery and then later between6and57months (mean23months) postoperatively using echocardiography for aortoplasty group’s survival(n=49). The changes of postoperative diameter of two groups were analysed.ResultsThe aortoplasty group’s perioperative mortality was2%(1case), and the replacement group’s perioperative mortality was3%(1case). In aortoplasty group, respiratory insufficiency occurred in1case and reopen operation was applied in1case, but both were cured later. In replacement group, renal failure occurred in1case and reopen operation was applied in1case, but both were cured later. Cardiopulmonary bypass time, aortic cross clamp time, blood transfusion volume and total hospital days of aortoplasty group were significantly less than that of replacement group, especially in blood transfusion volume. Postoperative ventilator time, ICU stay time were no significant difference between two groups. No late death and serious aorta-related complications were observed in two groups during follow-up. In aortoplasty group’s survival (n=49), preoperative, early postoperative and late postoperative of the ascending aorta diameter measuring by echocardiography were statistically significant difference. Further, by pairwise comparison between preoperative and early postoperative of the ascending aorta diameter, between preoperative and late postoperative of the ascending aorta diameter, the differences were statistically significant. But it was no significant difference between the postoperative early and late. The difference in two groups’changes of diameter between postoperative early and late was no statistically significant.Conclusions1In the patients with dilatation of the ascending aorta associated with aortic valve disease, it’s necessary for those who have ectatic ascending aorta of from40mm to55mm in diameter to be dealed with by surgical operations, except Marfan syndrome, aortic dissection, severe aortic atherosclerosis and so on.2That reduction ascending aortoplasty without external wrap which reduce the ascending aorta diameter to32mm-35mm is reasonable and feasible therapeutic strategy and has a satisfactory surgical result, especially for those patients that their diameter of the ascending aorta is from40mm to50mm. As for patients that their aortic wall have potential lesions in physical structure should strictly follow the preoperative ascending aorta diameter not more than50mm surgical indications.3The greater preoperative diameter of the ascending aorta and the not enough degree of postoperative reduction is the potential risk factor of redilatation.