Mid term follow up in patients with reduction ascending aortoplasty

Objective: The reduction plasty of the ascending aorta in patients with an asymptomatic aortic ectasia/dilatation (max. 50mm) is a common procedure during cardiac operations. Aim of the follow up study was the evaluation of possible re-dilatation and complications.

Methods: From 2002 to 2010 117 patients (62% male; mean age 66.6±10ys) with ectasia of the ascending aortic who had no further indication for an aortic replacement, were included. The mean preoperative diameter of the ascending aorta was 4.4±0.4cm. The patients risk profile was moderate (mean EF 51%±11%, Euroscore 4.2±2.1). To treat the dilatation of the ascending aorta, a longitudinal incision was performed and a strip of the aortic wall was resected. A reduction aortoplasty was carried out with a double-layered suture line using a 4/0 Prolene mattress suture with an additional 4/0 Prolene running suture. A follow up (rate 94%) was performed by echocardiography-, clinical examination and a quality of life questionnaire (SF12).

Results: All patients underwent reduction aortoplasty associated with a primary cardiac surgical procedure (AVR 76%, CABG 12%, other 12%). The intrahospital mortality rate was 2%. Two aortic bleeding complications occurred. After a mean postoperative period of 4.3 years, the ascending aortic diameter (3.7±4.5cm) was still significantly (P<0.01) reduced. No postoperative aortic-related complications including aortic rupture, dissection and reoperation were observed. In 4 patients, the ascending aorta had re-dilated to the preoperative diameter.

Conclusion: Reduction ascending aortoplasty with external wrapping is a safe procedure with acceptable midterm results in patients with asymptomatic dilatations and concomitant cardiac surgical procedures.