Selective management of high risk patients with an ascending aortic dilatation during aortic valve replacement

The ascending aortic dilatation secondary to aortic valve disease may be a risk for rupture or dissection unless it is not corrected with a graft replacement during valve surgery. This additional procedure requires prolonged operation time that can be harmful for the critical patient. External reinforcement of diseased aorta is an old but simple method with debated long term results, providing brief duration and lower complication rate of the aneurysm operation for critically ill patients whose life expectancy is poor.

Twenty-two patients underwent aortic valve replacement and external aortic wrapping procedure in our clinic. All of the patients had severe associated risk factors to complicate the classical aortic graft replacement procedure. In this prospective clinical study, the follow-up period of the patients is 79.91 patient-years.

There was no operative mortality. The average hospital stay was 8.6+/-2.6 days. There was no late death or cardiac morbidity. All of the patients were in NYHA Class 1 at postoperative 3rd month and thereafter. In CT scans the mean preoperative ascending aortic diameter was 5.12+/-0.38 cm while the mean diameter at 3rd month postoperatively was 3.19+/-0.25 cm. The reduction in diameter showed a significant difference (p<0.0001). The time related changes in luminal diameters showed some enlargement within the first year of the operation (p=0.03) that remained the same thereafter.

The early results and 4 years follow-up suggest that the technique can be regarded as safe and effective in selected high risk patients.