Title : Surgical treatment of poststenotic aneurysms of ascending aorta: Wraping tape operation is better?
Abstract:
Aim: To research possibilities of surgical treatment of poststenotic aneurysms of ascending aorta (PAAA) by different methods.
Methods: During 01.01.2000- 01,01.2025 yy 494 patients (pts) with aortic stenoses (AS) and PAAA were consecutively operated in Institute. The average age of pts was 57,2±8,2 (18 –73) yy. Males 324 (65,6%), females 170 (34,4%). At all group 26 (5,3 %) pts were in II NYHA class, 307 (62,1%) pts were in III NYHA class and 141 (28,6%) pts in IV. The following operations were performed: aortic valve replacement (AVR) + wrapping tape operation (WTO) of AA – 287 pts (group A), replacement of AA by vascular graft (n=207): Benthal’s (n= 181) and Wheat’s (n= 26) 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 was 0,3% in group A, 2,3% in group B (p < 0.05). Cross-clamping time (min) were: (group A) - 68,5±11,1 (group B - 122,9±21,7 (p < 0.05). During remote period (average 21,5±5,6 yy) we followed-up 389 pts. Actuarial survival at 20 years after operation was occured in group A – 67,5% (n=232), in group B – 41,8% (n= 307) (p<0.05).Echo examination of diameter of AA for group A (cm): preoperative (PRE) 4,4±0,5, postoperative (POST) (6–7 days) 3,3±0,4, remote period (RP) 3,4±0,3; for group B: preoperative 5,9±0,6, 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 poststenotic 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.
