Preserved Windkessel function in patients following reduction aortoplasty of the ascending aorta

Abstract

Objective: Reduction ascending aortoplasty (RAA) is a controversial procedure. Agreement has not yet been made regarding the indication for surgery and surgical technique. The goal of this study was to examine the long-term outcome of RAA without external support, and to compare the accuracy of transthoracic echocardiographic with computed tomographic (CT) measurements. Of particular interest was whether the important elastic properties of the aorta, the Windkessel function, is preserved following reduction aortoplasty of the ascending aorta without external wrapping.

Methods: Ninety-eight patients with dilation of the ascending aorta underwent reduction aortoplasty with concomitant cardiac procedures. Fifty-four patients were available for follow-up. Measurement of the ascending aortic diameter was performed prior to and directly following surgery, and 37 months postoperatively (range: 10-96 months). Both echocardiography and CT imaging were performed. The elastic properties of the ascending aorta were determined by measuring the distension of the ascending aorta during diastole and systole by means of transthoracic echocardiography. Fifteen patients with graft replacement of the ascending aorta were examined, and the control group contained 11 healthy volunteers.

Results: The diameter of the ascending aorta was significantly reduced in all patients who had undergone RAA. The change in diameter between diastole and systole was 3 mm in patients with reduction aortoplasty. Patients with graft replacement had a change of only 0.07 cm. There was no relevant increase (2 mm) in diameter at follow-up. Echocardiographic and CT measurements of the aortic diameter did not differ.

Conclusions: RAA without external wrapping shows good long-term results in patients with a dilated ascending aorta who underwent concomitant cardiac procedures. Echocardiography is very accurate in measuring the ascending aortic diameter, which makes it a cost-effective diagnostic tool. Moreover, ascending aortoplasty without external wrapping preserves the important elastic properties, namely the Windkessel function. Follow-up of the cardiac function and aortic diameter can be performed easily and precisely in the outpatient setting.