Title : Wrap or not to wrap of ascending aorta during surgical treatment of its poststenotic aneurysms is it the better option?
Abstract:
Aim:To research possibilities of surgical treatment of poststenotic aneurysms of ascending aorta (PAAA) by different methods.
Methods: During 2000-2023 yy 454 patients (pts) with aortic stenoses (AS) and PAAA were consecutively operated in Institute. The average age of pts was 58,2±9,1 (18 –73) yy. Males 304 (67,0%), females 150 (33,0%). At all group 21 (4,6 %) pts were in II NYHA class, 282 (62,1%) pts were in III NYHA class and 131 (33,3%) pts in IV. The following operations were performed: aortic valve replacement (AVR) + wrapping tape operation (WTO) of AA – 277 pts (group A), replacement of AA by vascular graft (n=177): Benthal’s (n= 156) and Wheat’s (n= 21) operations (group B). In all cases in group A after AVR nylon tape (diameter 1 cm) was wrapped on AA from the basement of noncoronary cusp by 7-9 tours and fixated between them in proximal and distal part of AA and resection of AA in incision`s area. All operations were performed with CPB, moderate hypothermia (27 - 32 C), combined retro-antegrade crystalloid cardioplegia(mainly Custadiol).
Results: Hospital mortality were 0,3% in group A, 2,9% in group B (p < 0.05). Cross-clamping time (min) were: (group A) - 71,5±12,4, (group B - 124,9±19,8 (p < 0.05). During remote period (average 15,4±7,6 yy) we followed-up 349 pts. Actuarial survival at 10 years after operation was occured in group A – 81,5% (n=232), in group B – 53,8% (n= 117) (p<0.05). Echo examination of diameter of AA for group A (cm): preoperative (PRE) 4,5±0,5, postoperative (POST) (6–7 days) 3,4±0,6, remote period (RP) 3,5±0,4; for group B: preoperative 5,6±0,7, postoperative – 3,3±0,4, remote period 3,4±0,2. Reoperations (AA`s graft replacement) were absents in group A and B.
Conclusion: On the basis of our experience we recommend the expedient method of wrapping tape operation for moderate forms of AAA (diameter of AA till 5,5 cm) during AVR. Reconstruction of AA for PAAA by WTO is safe, chiper and prevents AAA at the remote period.
