title: Reduction aortoplasty: safe and durable treatment for borderline dilatation in selected patients.
abstract: OBJECTIVE
  In aortic valve surgery, the management of ascending aortic dilatation is not clearly defined. Guidelines recommend replacement at diameters of 50 mm, but the handling of borderline dilatation has not been detailed. Reduction aortoplasty has been proposed as a less invasive and safe option in the case of a smaller dilatation above the sinotubular junction.
  
  
  METHODS
  Between 1999 and 2009, reduction aortoplasties with or without external reinforcement associated with aortic valve surgery were performed in 82 patients. The ascending aortic diameter was measured echocardiographically at a mean follow up (FU) of 32 months (FU was 91% complete).
  
  
  RESULTS
  The in-hospital mortality was 1.2%, and all patients were in NYHA class I or II. Echocardiography revealed a re-dilatation (> or = 5 mm) rate of 5.5%. One patient required reoperation. At univariate analysis, a preoperative dilatation >45 mm, persistent postoperative diameters >35 mm after reduction, and a younger age at the time of surgery (<65 years) were significant risk factors. Multivariate analysis confirmed the parameters for re-dilatation, and the area under the receiver operating curve was 0.85 for these three criteria. Mesh implantation, FU duration and bicuspid valve had no significant impact on outcome.
  
  
  CONCLUSIONS
  Reduction aortoplasty is a less-invasive option to handle borderline supra-coronary aneurysms in the case of concomitant valve surgery, compared to aortic replacement. The mortality remained low, and equal to that for simple aortic valve replacement. A large preoperative aortic diameter and age < or = 65 years favored re-dilatation. Correct downsizing was technically demanding, but indispensable for long-term stabilization. Regard for these criteria could lead to numerous patients benefiting from this operative strategy, with good results.
authors.affiliation: Department of Cardiovascular Surgery, CHUV, Lausanne, Switzerland. Lars.Niclauss@CHUV.ch
authors.forename: Lars
authors.initials: L
authors.lastname: Niclauss
authors.forename: Dominique
authors.initials: D
authors.lastname: Delay
authors.forename: Patrick
authors.initials: P
authors.lastname: Ruchat
authors.forename: Ludwig Karl
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome