Wrapping in Ascending Aortic Aneurysms as an Alternative for Replacement: Is It Beneficial?

Abstract

Background Prosthetic replacement of aneurysms of the ascending aorta is the gold standard in terms of long-term stability. Wrapping seems to be a less invasive procedure. It has not yet been shown if it is as safe in terms of long-term outcome.

Methods We present a single-center analysis of our experience over 13 years. We retrospectively analyzed data from patients who received either aortic prosthetic wrapping (AW) or aortic prosthetic replacement (AR) with or without aortic valve replacement and assessed them through phone calls. We used propensity score matching to adjust the baseline of the groups.

Results Before propensity matching, 144 patients received AW and 91 patients underwent AR. Mean age was 64 ± 11.8 years. After propensity score matching and adjusting for significant differences in age, gender, body mass index, logistic EuroSCORE I, and left ventricular function, 69 patients in each group remained for further analysis. Rate of early reoperation due to tamponade, inhospital mortality, and survival rates did not differ. In both groups, the surgically treated aortic segment did not show enlargement, whereas the nontreated aortic arch showed comparable aneurysmatical progression.

Conclusions AW is safe and feasible and can be used in elderly or frail patients in order to avoid an AR. Progression of the remaining native aortic segments occurs, thus requiring strict life-long follow-up to ensure an elective and thus safe approach for appropriate consecutive surgical measures, if required.

Keywords

aortic surgery - aneurysm - wrapping - aortic replacement - frailty

Disclosure

Dr. Laux, Dr. Ostovar, Mr. Schröter, and Mr. Braun had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects.

^* Magdalena L. Laux and Roya Ostovar contributed equally to the manuscript.

• References

• 1 Erbel R, Aboyans V, Boileau C. , et al; ESC Committee for Practice Guidelines; The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014; 35 (41) 2873-2926
• 2 Beddermann C, Norman JC, Cooley DA. Combined replacement of the ascending aorta and the aortic valve in 42 consecutive patients: a comparison of composite graft and conventional techniques over one year. Thorac Cardiovasc Surg 1980; 28 (02) 89-95
• 3 Robicsek F, Daugherty HK, Mullen DC. , et al. Long-range observations with external aortic grafts. J Cardiovasc Surg (Torino) 1976; 17 (03) 195-201
• 4 Dhillon JS, Randhawa GK, Straehley CJ, McNamara JJ. Late rupture after Dacron wrapping of aortic aneurysms. Circulation 1986; 74 (3 Pt 2): I11-I14
• 5 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 (04) 693-697
• 6 Egloff L, Rothlin M, Kugelmeier J, Senning A, Turina M. The ascending aortic aneurysm: replacement or repair?. Ann Thorac Surg 1982; 34 (02) 117-124
• 7 Nishimura RA, Otto CM, Bonow RO. , et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 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 Practice Guidelines. J Am Coll Cardiol 2014; 63 (22) e57-e185
• 8 Borger MA, Preston M, Ivanov J. , et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?. J Thorac Cardiovasc Surg 2004; 128 (05) 677-683
• 9 Carrel T, von Segesser L, Jenni R. , et al. Dealing with dilated ascending aorta during aortic valve replacement: advantages of conservative surgical approach. Eur J Cardiothorac Surg 1991; 5 (03) 137-143
• 10 Williams JB, Peterson ED, Zhao Y. , et al. Contemporary results for proximal aortic replacement in North America. J Am Coll Cardiol 2012; 60 (13) 1156-1162
• 11 Markewitz A, Weinhold C, Kemkes BM, Reichart B, Hemmer W, Klinner W. Surgical treatment of aneurysms of the ascending aorta. Twelve years' experience in 66 patients. Thorac Cardiovasc Surg 1986; 34 (05) 287-291
• 12 Zierer A, Melby SJ, Lubahn JG, Sicard GA, Damiano Jr RJ, Moon MR. Elective surgery for thoracic aortic aneurysms: late functional status and quality of life. Ann Thorac Surg 2006; 82 (02) 573-578
• 13 Wittenstein GJ. Complications of aortic aneurysm surgery: prevention and treatment. Thorac Cardiovasc Surg 1987; 35 (Spec No 2): 136-139
• 14 Feindt P, Litmathe J, Börgens A, Boeken U, Kurt M, Gams E. Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery?. Eur J Cardiothorac Surg 2007; 31 (04) 614-617
• 15 Zhang H, Lu F, Qu D. , et al. Treatment of fusiform ascending aortic aneurysms: a comparative study with 2 options. J Thorac Cardiovasc Surg 2011; 141 (03) 738-743
• 16 Dzsinich M, Tarr F, Schaff HV. Management of ascending aortic aneurysm and valvular incompetence with external remodeling. Interact Cardiovasc Thorac Surg 2007; 6 (03) 409-410
• 17 Pecoraro F, Shingaki M, Steuer J. , et al. Treatment of isolated ascending aortic aneurysm by off-pump epiaortic wrapping is safe and durable. Interact Cardiovasc Thorac Surg 2016; 23 (02) 286-291
• 18 Lee SH, Kim JB, Kim DH. , et al. Management of dilated ascending aorta during aortic valve replacement: valve replacement alone versus aorta wrapping versus aorta replacement. J Thorac Cardiovasc Surg 2013; 146 (04) 802-809
• 19 Kiessling AH, Odwody E, Miskovic A, Stock UA, Zierer A, Moritz A. Midterm follow up in patients with reduction ascending aortoplasty. J Cardiothorac Surg 2014; 9: 120
• 20 Harder T, Nicolas V, Steudel A, Orrelano L. Radiological diagnosis of the thoracic aortic aneurysm. Thorac Cardiovasc Surg 1987; 35 (Spec No 2): 122-125
• 21 Arsan S, Akgun S, Kurtoglu N, Yildirim T, Tekinsoy B. Reduction aortoplasty and external wrapping for moderately sized tubular ascending aortic aneurysm with concomitant operations. Ann Thorac Surg 2004; 78 (03) 858-861