Suture reduction of the borderline ascending aortic dilatation during aortic valve replacement

This study was conducted to evaluate the efficacy of simple suture reduction of the ascending aorta (SRA) performed with aortic valve replacement (AVR) in patients with borderline ascending aortic dilatation (45-50 mm).

Ninety-eight patients (ascending aortic diameter 47.7±3.4 mm) who underwent concomitant SRA with AVR were enrolled. Median follow-up duration was 83 (IQR 27-173) months. Computed tomographic angiography (CTA) follow-up was performed at 71 (47-149) months after surgery (N.=69). At least two CTA scans were performed in 34 patients (interval = 63 [46, 156] months). Early and long-term outcomes were evaluated, and dilatation rate (mm/year) of the repaired aorta was analyzed. Major adverse aortic events (MAEs) were defined as death related to aortic events, including sudden death, aortic rupture or dissection, aortic reoperation and recurrent aortic aneurysm (>45 mm).

Early mortality rate was 2.0%. No patients had postoperative complications associated with SRA. A recurrent aortic aneurysm (>45 mm) was found in nine patients, but none of the patients had an ascending aorta diameter >50 mm. A multivariable analysis demonstrated that neither preoperative diameter of the ascending aorta nor bicuspid valve was associated with dilatation of the repaired aorta. Co-existing coronary artery disease was associated with both recurrent aneurysm and increased dilatation rate after SRA. There were two cases of sudden death and no one suffered from aortic dissection, rupture or aortic reoperation. Ten- and 20-year freedom rates from MAE were 90.3% and 79.3%, respectively.

Concomitant SRA might be a safe and effective surgical alternative to ascending aorta replacement in AVR patients with borderline ascending aortic dilatation regardless of aortic valve pathology.