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Effects of ascending aorta replacement on aortic root dilatation
Ruggero De Paulis1, Enrico Cetrano, Marco Moscarelli
1Department of Cardiac Surgery, University of Tor Vergata, Rome, Italy. depauli@tin.it
Summary
Ascending aorta replacement can increase aortic root dimension, especially after acute aortic dissection. This progression necessitates aggressive aortic root treatment in such cases, unlike chronic aneurysms.
Area of Science:
- Cardiovascular Surgery
- Aortic Aneurysm Research
- Medical Imaging
Background:
- Prosthetic replacement of the ascending aorta may increase aortic root wall stress.
- This stress could be a risk factor for progressive aortic root dimension increase.
Purpose of the Study:
- Evaluate aortic root diameter changes after ascending aorta replacement.
- Assess progression of aortic valve regurgitation in relation to etiology.
Main Methods:
- Echocardiographic assessment of 63 late survivors post-ascending aorta replacement.
- Comparison of aortic root diameter and valve regurgitation between early and late follow-up.
- Stratification into acute aortic dissection (n=41) and chronic atherosclerotic aneurysm (n=22) groups.
Main Results:
- Aortic root diameter increased significantly (P<0.0001) in 25% of patients, primarily those with acute aortic dissection.
- Seven patients (17%) with acute dissection required reoperation for aortic root issues.
- Worsening aortic valve insufficiency occurred mainly in acute dissection patients, particularly with root dilatation.
Conclusions:
- Progressive aortic root dilatation and worsening aortic valve insufficiency after surgery are linked to acute aortic dissection.
- More aggressive aortic root treatment is recommended for acute aortic dissection, but not for chronic atherosclerotic aneurysms.