Calculated Reduction Aortoplasty for Dilatation of the Ascending Aorta Associated with Aortic Valve Replacement

Authors

  • George Stavridis
  • Dimitris Zarkalis
  • Louis Louca
  • Loukas Tsourelis
  • Peter Alivizatos

DOI:

https://doi.org/10.1532/HSF98.20041045

Abstract

Background: Previous studies have advocated reduction aortoplasty to normalize the diameter of a moderately dilated ascending aorta associated with aortic valve disease. One of the reported techniques is the shawl lapel aortoplasty, which we have adopted and modified by setting a simple set of calculations. We present our midterm results.

Methods: Between February 1996 and February 2004, 25 patients underwent reduction aortoplasty during replacement of their aortic valves. Concomitant cardiac procedures were performed in 11 patients. Eighteen patients had predominantly severe aortic valve stenosis and 7 patients moderate to severe aortic valve insufficiency. Ascending aortic aneurysm size ranged from 43 to 50 mm, measured echocardiographically. In one small sized patient the aorta was 38 mm. Following their discharge patients were instructed to have control echocardiograms every 6 months for the first postoperative year and then annually. They were interviewed by telephone annually to date.

Results: There were no hospital deaths. Twenty-four patients were alive at follow-up, at 2 to 96 months (average 2.9 years). There was one late death, 2 years postoperatively. The first follow-up transthoracic echocardiogram performed at a mean of 6.2 months postoperatively (range, 1-11 months), as well as the subsequent annual echocardiograms in all patients, showed no evidence of further enlargement of the ascending aorta, compared to the reduced diameter obtained during the initial operation. The first 3 patients of this study remained essentially unchanged postoperatively, with only a minor reduction of their aortic diameter.

Conclusions: The shawl lapel technique based on simple calculations, used as a diameter-reduction strategy for ascending aortic dilatation encountered during aortic valve replacement, is an efficacious method with excellent medium-term results.

References

Barnett M, Fiore A, Vaca K, Milligan T, Barner H. 1995. Tailoring aortoplasty for repair of fusiform ascending aortic aneurysms. Ann Thorac Surg 59:497-501.nBauer M, Pasic M, Schaffarzyk R, et al. 2002. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg 73:720-4.nBaumgartner F, Omari B, Pak S, Gintzon L, Shapiro S, Milliken J. 1998. Tailoring aortoplasty for moderately sized ascending aneurysms. J Card Surg. 13:129-32.nEgloff L, Rothlin M, Kugelmeier J, Senning A, Turina M. 1982. The ascending aortic aneurysm: replacement or repair? Ann Thorac Surg 34:117-24.nHarrison L Jr, Heck H Jr. Shawl lapel aortoplasty. 1996. Ann Thorac Surg 62:1867.nKon N. 2002. Invited commentary on: Bauer M, Pasic M, Schaffarzyk R, Siniawski H, Knollmann F, Meyer R, Hetzer R. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg 73:720-4.nLytle BW, Mahfood SS, Cosgrove DM, Loop FD. 1990. Replacement of the ascending aorta. Early and late results. J Thorac Cardiovasc Surg 99:651-8.nMcCready RA, Pluth JR. 1979. Surgical treatment of ascending aortic aneurysms associated with aortic valve insufficiency. Ann Thorac Surg 28:307-16.nMueller X, Tevaearai H, Genton C, et al. 1997. Drawback of aortoplasty for aneurysm of the ascending aorta associated with aortic valve disease. Ann Thorac Surg 63:762-6.nNajafi H. 1997. Invited commentary on: Mueller X, Tevaearai H, Genton C, Hurni M, Ruchat P, Fischer A, Stumpe F, von Segesser L. Draw back of aortoplasty for aneurysm of the ascending aorta associated with aortic valve disease. Ann Thorac Surg 63:766-7.nNeri E, Massetti M, Tanganelli P, et al. 1999. Is it only a mechanical matter? Histologic modifications of the aorta underlying external banding. J Thorac Cardiovasc Surg 118:1116-8.nRobiscek F. 1981. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: an alternative to radical resection. Ann Thorac Surg 34:92-4.nRobicsek F. 1995. Invited commentary on: Barnett M, Fiore A, Vaca K, Milligan T, Barner H. Tailoring aortoplasty for repair of fusiform ascending aortic aneurysms. Ann Thorac Surg 59:497-01.n

Published

2005-01-04

How to Cite

Stavridis, G., Zarkalis, D., Louca, L., Tsourelis, L., & Alivizatos, P. (2005). Calculated Reduction Aortoplasty for Dilatation of the Ascending Aorta Associated with Aortic Valve Replacement. The Heart Surgery Forum, 7(4), E309-E311. https://doi.org/10.1532/HSF98.20041045

Issue

Section

Articles

Most read articles by the same author(s)