Early impact of aortic wrapping on patients undergoing aortic valve replacement with mild to moderate ascending aorta dilatation

Abstract

Background: The management of mild to moderate dilatation of the ascending aorta of less than 5 cm is controversial, particularly when concomitant surgical correction of aortic valve is required. We investigate the impact of a simple method of aorta reduction using Dacron graft wrapping during aortic valve replacement on the rest of the aorta.

Methods: We studied 14 patients who had ascending aorta dilatation of 4-5 cm before undergoing aortic wrapping during their aortic valve replacement and compared with their post-operative imaging within a month.

Results: The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within 4 weeks after surgery from 44.7 +/- 2.6 to 33.6 +/- 3.9 mm (p < 0.001). This was associated with significant reduction in the diameter of rest of ascending aorta: coronary sinuses (from 37.9 +/- 4.9 mm to 33.3 +/- 6.1 mm; p < 0.001), sinotubular junction (from 33.2 +/- 4.7 mm to 30.6 +/- 4.4 mm, p = 0.02), and aortic arch (from 34.7 +/- 4.3 mm to 32.6 +/- 4.1 mm, p = 0.03).

Conclusions: Reduction of ascending aortic dilatation by wrapping with a Dacron graft in this preliminary study is associated with favourable early reversed aortic remodelling. This supports the hypothesis that correction of mild-moderate dilatation of the ascending aorta with Dacron wrapping at the time of aortic valve surgery may prevent the progression of the dilatation, although the long-term study on a larger population is needed to confirm its benefits.

Figure 1

Mean values of the dimensions of the ascending aorta (a), coronary sinuses (b), sinotubular junction (c) and aortic arch (d) before and after wrapping of the ascending aorta with a Dacron graft. *p < 0.05 versus before correction values.