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The Journal of Cardiovascular Surgery 2021 May 20

DOI: 10.23736/S0021-9509.21.11543-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

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

Yeiwon LEE 1, Ho Y. HWANG 1 , Eun-Ah PARK 2, Myoung-jin JANG 3, Suk H. SOHN 1, Jae W. CHOI 1

1 Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea; 2 Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea; 3 Medical Research Collaborating Center, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea


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BACKGROUND: 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(45-50mm).
METHODS: 98 patients (ascending aortic diameter=47.7±3.4mm) who underwent concomitant SRA with AVR were enrolled. Median follow-up duration was 83 (interquartile=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(>45mm).
RESULTS: Early mortality rate was 2.0%. No patients had postoperative complications associated with SRA. A recurrent aortic aneurysm(>45mm) was found in 9 patients, but none of the patients had an ascending aorta diameter>50mm. 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 2 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.
CONCLUSIONS: 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.


KEY WORDS: Aortic; Aneurysm; CT-angiography

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