Aortic wrapping for a dilated ascending aorta in bicuspid aortic stenosis.
BACKGROUND
Ascending aorta wrapping is rarely recommended for the management of dilated aorta, because of late complications. The aim of the present study was to analyze the early and late outcomes of the aortic wrapping technique at the time of aortic valve replacement (AVR) for bicuspid aortic stenosis (BAS).


RESULTS
Among patients who underwent primary AVR for BAS between 2002 and 2011, 79 who underwent ascending aortic wrapping (wrapping group) were compared with 144 patients who underwent AVR alone. The preoperative ascending aortic diameters were larger in the wrapping group (40.9±4.2 mm vs. 48.6±4.0 mm, P<0.001). Operative technique was to wrap the ascending aorta transversely with a semi-elliptically resected Dacron graft. The follow-up for the wrapping group was 76.5±35.5 (median 71.1) months. There were no early deaths. Early and late morbidity did not differ between groups. The 24 late deaths, including 10 cardiac-related deaths, occurred in the entire group; 3 sudden deaths occurred only in the AVR group. The 10-year overall survival in the wrapping group was higher than the AVR group (88.1±6.8% vs. 80.0±4.6%, P=0.048). No late aortic complications were detected. The aortic diameter was reduced from 49.5±4.1 mm to 45.3±5.0 mm after wrapping (P<0.001).


CONCLUSIONS
The aortic wrapping technique may be an option for treating a moderately dilated ascending aorta in selected patients undergoing AVR for BAS. Longer follow-up, however, is necessary to verify later complications.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Min Suk
MS
Choi
Dong Seop
DS
Jeong
Hae Young
HY
Lee
Kiick
K
Sung
Wook Sung
WS
Kim
Young Tak
YT
Lee
Pyo Won
PW
Park
D000368:Aged; D001011:Aorta / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D004108:Dilatation, Pathologic / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies