The long-term fate of ascending aorta aneurysm after wrapping versus replacement

Area of Science:

• Cardiovascular Surgery
• Aortic Diseases
• Medical Devices

Background:

• Ascending aorta dilation is a common complication requiring surgical intervention.
• Aortic valve surgery often involves managing ascending aorta dimensions.
• Long-term outcomes of aortic repair techniques require further investigation.

Purpose of the Study:

• To evaluate the long-term fate of aortic diameter after wrapping or replacement in moderately dilated ascending aortas.
• To compare the durability of aortic wrapping versus replacement in patients undergoing aortic valve surgery.
• To identify risk factors for aortic diameter re-expansion post-procedure.

Main Methods:

• Retrospective review of 204 patients undergoing aortic valve replacement with ascending aorta wrapping (n=96) or replacement (n=108).
• Analysis of aortic diameter changes at the annulus, sinus, ascending aorta, and proximal arch using a linear mixed-effect model.
• Propensity score matching and multivariable competing risk analysis to assess outcomes and risk factors.

Main Results:

• Neither aortic wrapping nor replacement resulted in redilation of the annulus, sinus, or ascending aorta.
• The proximal aortic arch diameter significantly increased annually in the wrapping group (0.343 mm/year) but not in the replacement group (0.066 mm/year).
• Initial ascending aorta diameter >47.2 mm was an independent risk factor for proximal arch redilation after wrapping.

Conclusions:

• Aortic wrapping and replacement demonstrate long-term durability for moderately enlarged ascending aortas.
• Aortic wrapping is a viable option, but careful monitoring for proximal arch redilation is recommended.
• Initial ascending aorta diameter is a key predictor of proximal arch behavior after wrapping.