title: The effect of proximal anastomosis on the expansion rate of a dilated ascending aorta in coronary artery bypass surgery: a prospective study.
abstract: BACKGROUND
  This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention.
  
  
  METHODS
  The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42-80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta).
  
  
  RESULTS
  A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups.
  
  
  CONCLUSIONS
  In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively.
authors.affiliation: Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yavuz Balci
authors.affiliation: Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey. Email: unsalvural@gmail.com.
authors.forename: Unsal
authors.initials: U
authors.lastname: Vural
authors.affiliation: Department of Cardiovascular Surgery, Kosuyolu Training and Research Hospital, Istanbul, Turkey.
authors.forename: Rezan
authors.initials: R
authors.lastname: Aksoy
authors.affiliation: Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey.
authors.forename: M Fatih
authors.initials: MF
authors.lastname: Özdemir
authors.affiliation: Department of Cardiology, Acibadem University, Istanbul, Turkey.
authors.forename: Seçkin
authors.initials: S
authors.lastname: Satilmiş
authors.affiliation: Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kizilay
authors.affiliation: Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Şenocak
authors.affiliation: Department of Cardiovascular Surgery, Derince Training and Research Hospital, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Şaşkin
authors.affiliation: Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey.
authors.forename: Ilyas
authors.initials: I
authors.lastname: Kayacioğlu
authors.affiliation: Department of Cardiovascular Surgery, Dr Siyami Ersek Cardiovascular Surgery and Thoracic Hospital, Istanbul, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yekeler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004108:Dilatation, Pathologic; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome