Early and Mid-term Results of Reduction Ascending Aortoplasty_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGYan , ZHAOWei ,  PANShi-wei , SUNHan-song , HUSheng-shou , TANGYue , WANGWei , XUJian-ping

State Key Laboratory of Cardiovascular Disease, Department of Cardiac Surgery, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

PANShi-wei, Email: waikezhangyan@126.com

Keywords：

Ascending aortoplasty; Ascending aortic dilatation; Aortic valve replacement

DOI：

10.7507/1007-4848.20140129

Video：

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Objective To assess early and mid-term outcomes and our clinical experience of reduction ascending aortoplasty (RAA) for patients with aortic valve disease and ascending aortic dilatation, and improve treatment effects. Methods Clinical data of 36 patients with aortic valve disease and ascending aortic dilatation who underwent aortic valve replacement and RAA in Fu Wai Hospital between January 2002 and August 2010 were retrospectively analyzed. There were 26 male and 10 female patients with their age of 7-72 (51±16) years. Ascending aorta diameter (AAD) was measured by echocardiography preoperatively, postoperatively, during follow-up and compared. Results There was no perioperative death. Cardiopulmonary bypass time was 96.2±28.3 minutes, and aortic cross-clamp time was 69.2±22.1 minutes. Posto-perative hospital stay was 11.0±7.8 days. All the 36 patients were followed up after discharge for 1.1-9.0 (4.0±2.3) years. During follow-up, there was 1 death, but none of the patients needed reoperation. Echocardiography showed normal aortic valve function. Postoperative AAD was significantly smaller than preoperative AAD (36.4±6.1 mm vs. 46.8±4.6 mm, t=13.12, P=0.00). AAD during follow-up was significantly larger than postoperative AAD (40.8±6.8 mm vs. 36.4±6.1 mm, t=-2.64, P=0.01) but significantly smaller than preoperative AAD (40.8±6.8 mm vs. 46.8±4.6 mm, t=3.48, P=0.00). Conclusion Early and mid-term outcomes of RAA are satisfactory for patients with aortic valve disease and ascending aortic dilatation, but long-term results need further observation.

Citation： ZHANGYan, ZHAOWei, PANShi-wei, SUNHan-song, HUSheng-shou, TANGYue, WANGWei, XUJian-ping. Early and Mid-term Results of Reduction Ascending Aortoplasty. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 457-459. doi: 10.7507/1007-4848.20140129 Copy

1.	Robicsek F, Cook JW, Reames MK Sr, et al. Size reduction ascen-ding aortoplasty:is it dead or alive? J Thorac Cardiovasc Surg, 2004, 128(4):562-570.
2.	Sievers HH. Reflections on reduction ascending aortoplasty's liveliness. J Thorac Cardiovasc Surg, 2004, 128 (4):499-501.
3.	Gill M, Dunning J. Is reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta? Interact Cardiovasc Thorac Surg, 2009, 9 (4):693-697.
4.	Bauer M, Pasic M, Schaffarzyk R, et al. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg, 2002, 73 (3):720-724.
5.	Haddad R, Fagundes WV, Pinheiro BB. Reduction aortoplasty with external wrapping associated with aortic valve replacement in high-risk patients. Rev Bras Cir Cardiovasc, 2009, 24 (2):194-199.
6.	Della Corte A, De Feo M, Bancone C, et al. Long-term follow-up of reduction ascending aortoplasty with autologous partial wrapping:for which patient is waistcoat aortoplasty best suited? Interact Cardiovasc Thorac Surg, 2012, 14 (1):56-63.
7.	Zhang H, Lu FL, Qu D, et al. Treatment of fusiform ascending aortic aneurysms:a comparative study with 2 options. J Thorac Cardiovasc Surg, 2011, 141 (3):738-743.
8.	Hwang HY, Shim MS, Park EA, et al. Reduction aortoplasty for the ascending aortic aneurysm with aortic valve disease. Does bicuspid valve matter? Circ J, 2011, 75 (2):322-328.
9.	Mueller XM, Tevaearai HT, Genton CY, et al. Drawback of aortop-lasty for aneurysm of the ascending aorta associated with aortic valve disease. Ann Thorac Surg, 1997, 63 (3):762-767.
10.	Robicsek F, Thubrikar MJ. Conservative operation in the management of annular dilatation and ascending aortic aneurysm. Ann Thorac Surg, 1994, 57 (6):1672-1674.
11.	Takeshi K, Imanaka K, Ohuchi H, et al. Mid-term results of aortoplasty for dilated ascending aorta associated with aortic valve disease. Ann Thorac Cardiovasc Surg, 2003, 9 (4):253-256.
12.	Cotrufo M, Della Corte A, De Santo LS, et al. Asymmetric medial degeneration of the ascending aorta in aortic valve disease:a pilot study of surgical management. J Heart Valve Dis, 2003, 12 (2):127-135.
13.	郑向阳, 梁志强, 王平凡, 等.主动脉瓣病变合并升主动脉扩张主动脉成形术后疗效分析.中国循证心血管医学杂志, 2012, 4 (5):458-459.
14.	陈宝俊, 王东进, 曹彬, 等.主动脉成形术治疗合并主动脉瓣病变的升主动脉扩张.中国医师杂志, 2010, 12 (11):1499-1500.
15.	徐志云, 陆方林, 韩林, 等.升主动脉置换术或成形术治疗主动脉瓣病变合并的升主动脉瘤样扩张.中华胸心血管外科杂志, 2010, 26 (4):236-239.
16.	姜敏炎, 张剑平, 吴伟敏, 等.主动脉瓣二叶式畸形及合并升主动脉瘤样扩张的外科治疗.中国临床医学, 2010, 17 (2):159-160.
17.	Jonjev Z, Rosic M, Mihajlovic B, et al. Dilated ascending aorta:is reductive ascending aortoplasty really forgotten? J Thorac Cardiovasc Surg, 2013, 8 (Suppl 1):6.
18.	Belov IV, Stepanenko AB, Gens AP, et al. Reduction aortoplasty for ascending aortic aneurysm:a 14-year experience. Asian Cardiovasc Thorac Ann, 2009, 17 (2):162-166.
19.	符竣, 陶凉, 陈绪发, 等.简化升主动脉包裹成形术的临床效果评价.中华临床医师杂志:电子版, 2011, 5 (17):5190-5192.
20.	Walker T, Bail DH, Gruler M, et al. Unsupported reduction ascen-ding aortoplasty:fate of diameter and of Windkessel function. Ann Thorac Surg, 2007, 83 (3):1047-1053.
21.	Akgun S, Atalan N, Fazlioğullari O, et al. Aortic root aneurysm after off-pump reduction aortoplasty. Ann Thorac Surg, 2010, 90 (5):e69-e70.
22.	Abdulkareem N, Soppa G, Jones S, et al. Dilatation of the remaining aorta after aortic valve or aortic root replacement in patients with bicuspid aortic valve:a 5-year follow-up. Ann Thorac Surg, 2013, 96 (1):43-49.
23.	Polvani G, Barili F, Dainese L, et al. Reduction ascending aortop-lasty:midterm Follow-Up and predictors of redilatation. Ann Thorac Surg, 2006, 82 (2):586-591.
24.	李阳, 蒙炜, 张尔永.无包裹-纵切口升主动脉成形术治疗升主动脉扩张的疗效分析.中国修复重建外科杂志, 2012, 26 (7):819-822.

1. Robicsek F, Cook JW, Reames MK Sr, et al. Size reduction ascen-ding aortoplasty:is it dead or alive? J Thorac Cardiovasc Surg, 2004, 128(4):562-570.
2. Sievers HH. Reflections on reduction ascending aortoplasty's liveliness. J Thorac Cardiovasc Surg, 2004, 128 (4):499-501.
3. Gill M, Dunning J. Is reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta? Interact Cardiovasc Thorac Surg, 2009, 9 (4):693-697.
4. Bauer M, Pasic M, Schaffarzyk R, et al. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg, 2002, 73 (3):720-724.
5. Haddad R, Fagundes WV, Pinheiro BB. Reduction aortoplasty with external wrapping associated with aortic valve replacement in high-risk patients. Rev Bras Cir Cardiovasc, 2009, 24 (2):194-199.
6. Della Corte A, De Feo M, Bancone C, et al. Long-term follow-up of reduction ascending aortoplasty with autologous partial wrapping:for which patient is waistcoat aortoplasty best suited? Interact Cardiovasc Thorac Surg, 2012, 14 (1):56-63.
7. Zhang H, Lu FL, Qu D, et al. Treatment of fusiform ascending aortic aneurysms:a comparative study with 2 options. J Thorac Cardiovasc Surg, 2011, 141 (3):738-743.
8. Hwang HY, Shim MS, Park EA, et al. Reduction aortoplasty for the ascending aortic aneurysm with aortic valve disease. Does bicuspid valve matter? Circ J, 2011, 75 (2):322-328.
9. Mueller XM, Tevaearai HT, Genton CY, et al. Drawback of aortop-lasty for aneurysm of the ascending aorta associated with aortic valve disease. Ann Thorac Surg, 1997, 63 (3):762-767.
10. Robicsek F, Thubrikar MJ. Conservative operation in the management of annular dilatation and ascending aortic aneurysm. Ann Thorac Surg, 1994, 57 (6):1672-1674.
11. Takeshi K, Imanaka K, Ohuchi H, et al. Mid-term results of aortoplasty for dilated ascending aorta associated with aortic valve disease. Ann Thorac Cardiovasc Surg, 2003, 9 (4):253-256.
12. Cotrufo M, Della Corte A, De Santo LS, et al. Asymmetric medial degeneration of the ascending aorta in aortic valve disease:a pilot study of surgical management. J Heart Valve Dis, 2003, 12 (2):127-135.
13. 郑向阳, 梁志强, 王平凡, 等.主动脉瓣病变合并升主动脉扩张主动脉成形术后疗效分析.中国循证心血管医学杂志, 2012, 4 (5):458-459.
14. 陈宝俊, 王东进, 曹彬, 等.主动脉成形术治疗合并主动脉瓣病变的升主动脉扩张.中国医师杂志, 2010, 12 (11):1499-1500.
15. 徐志云, 陆方林, 韩林, 等.升主动脉置换术或成形术治疗主动脉瓣病变合并的升主动脉瘤样扩张.中华胸心血管外科杂志, 2010, 26 (4):236-239.
16. 姜敏炎, 张剑平, 吴伟敏, 等.主动脉瓣二叶式畸形及合并升主动脉瘤样扩张的外科治疗.中国临床医学, 2010, 17 (2):159-160.
17. Jonjev Z, Rosic M, Mihajlovic B, et al. Dilated ascending aorta:is reductive ascending aortoplasty really forgotten? J Thorac Cardiovasc Surg, 2013, 8 (Suppl 1):6.
18. Belov IV, Stepanenko AB, Gens AP, et al. Reduction aortoplasty for ascending aortic aneurysm:a 14-year experience. Asian Cardiovasc Thorac Ann, 2009, 17 (2):162-166.
19. 符竣, 陶凉, 陈绪发, 等.简化升主动脉包裹成形术的临床效果评价.中华临床医师杂志:电子版, 2011, 5 (17):5190-5192.
20. Walker T, Bail DH, Gruler M, et al. Unsupported reduction ascen-ding aortoplasty:fate of diameter and of Windkessel function. Ann Thorac Surg, 2007, 83 (3):1047-1053.
21. Akgun S, Atalan N, Fazlioğullari O, et al. Aortic root aneurysm after off-pump reduction aortoplasty. Ann Thorac Surg, 2010, 90 (5):e69-e70.
22. Abdulkareem N, Soppa G, Jones S, et al. Dilatation of the remaining aorta after aortic valve or aortic root replacement in patients with bicuspid aortic valve:a 5-year follow-up. Ann Thorac Surg, 2013, 96 (1):43-49.
23. Polvani G, Barili F, Dainese L, et al. Reduction ascending aortop-lasty:midterm Follow-Up and predictors of redilatation. Ann Thorac Surg, 2006, 82 (2):586-591.
24. 李阳, 蒙炜, 张尔永.无包裹-纵切口升主动脉成形术治疗升主动脉扩张的疗效分析.中国修复重建外科杂志, 2012, 26 (7):819-822.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early and Mid-term Results of Reduction Ascending Aortoplasty

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