title: Unsupported reduction ascending aortoplasty: fate of diameter and of Windkessel function.
abstract: BACKGROUND
  Moderate aneurysms of the ascending aorta that are associated with other cardiac diseases are frequently encountered by cardiac surgeons. Reduction ascending aortoplasty (RAA) provides an elegant technique to handle these aneurysms; however, its applicability is still under debate. Many surgeons reject RAA because of an assumed redilatation. We investigated the postoperative stability of RAA without external support and whether the elastic property of the aorta (Windkessel function) remains preserved.
  
  
  METHODS
  From 1996 to 2003, 97 patients (mean age, 67 years) underwent RAA without external stabilization in our institution as a concomitant procedure during cardiac surgery. The diameter of the ascending aorta was measured before and directly after surgery, as well as postoperatively from 10 to 96 months (median, 32 months).
  
  
  RESULTS
  The mean preoperative diameter was 4.55 +/- 0.43 cm, while the early postoperative diameter measured 3.53 +/- 0.44 cm. Fifty-four of the 97 patients were available for follow-up. The mean diameter measured at follow-up was 3.68 +/- 0.41 cm. The mean increase was 0.17 +/- 0.27 cm. There was no relevant difference in redilatation between patients with follow-up of more than 60 months or less. Furthermore, the aortic wall demonstrated a near normal diastolic-systolic augmentation assessed by echocardiography.
  
  
  CONCLUSIONS
  Reduction ascending aortoplasty without external stabilization is a reliable treatment for patients suffering from a moderately enlarged ascending aorta who require cardiac surgery for other indications. In these cases, with the technique described, a redilatation can be prevented and the Windkessel function of the ascending aorta remains preserved.
authors.affiliation: Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany. tobias.walker@med.uni-tuebingen.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Walker
authors.forename: Dorothee H L
authors.initials: DH
authors.lastname: Bail
authors.forename: Miriam
authors.initials: M
authors.lastname: Gruler
authors.forename: Reinhard
authors.initials: R
authors.lastname: Vonthein
authors.forename: Volker
authors.initials: V
authors.lastname: Steger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ziemer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D001027:Aortography; D003187:Compliance; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*; D014664:Vasodilation