Key result
Aortic wrapping during aortic valve replacement in patients with moderate ascending aortic dilation resulted in a 97.9% freedom from adverse aortic events at 10 years, though significant redilation occurred at the proximal aortic arch.
Why the study?
Long-term outcomes of aortic wrapping in patients with ascending aortic aneurysms remain poorly understood.
Does aortic wrapping during aortic valve replacement prevent aortic dilation and adverse events in patients with moderately dilated ascending aortas?
Cohort (n=96)
No
Does aortic wrapping during aortic valve replacement prevent aortic dilation and adverse events in patients with moderately dilated ascending aortas?
Aortic wrapping during aortic valve replacement is a safe long-term option that prevents ascending aorta dilation, though proximal arch redilation requires monitoring, especially if initial mid-ascending diameter is ≥47.0 mm.
May support evaluation of wrapping in moderate dilation during AVR; leaves open arch redilation durability for prospective trials.
The long-term outcomes of aortic wrapping in patients with ascending aortic aneurysms, which are rare, but can be fatal, remain poorly understood. This retrospective study analyzed the outcomes of aortic diameter, including aortic root, ascending aorta, and proximal arch diameters, after aortic wrapping during aortic valve replacement surgery. Materials and Methods: Ninety-six patients with ascending aortic dilation of 40-55 mm who underwent aortic wrapping during aortic valve replacement were selected for this study. Aortic diameter was measured at three levels perioperatively and at follow-up (median time of 9.14.2 years). A linear mixed-effects model was used to analyze aortic diameter expansion. Results: Freedom from adverse aortic events (aortic dissection or rupture, reoperation, or sudden death) at 10 years was 97.9%. No significant dilation at the level of the sinuses of Valsalva (0.069 mm/year, p=0.524) or ascending aorta (0.152 mm/year, p=0.124) was observed. Significant dilation occurred at the proximal aortic arch (0.343 mm/year, p=0.006). Subgroup analysis with a multivariable linear mixed model identified initial ascending aortic diameter to be a significant predictor of proximal arch dilation (p=0.032). Receiver operating characteristic curve analysis revealed that the cut-off for the prediction of proximal arch redilation was an initial mid-ascending aortic diameter of 47.0 mm (area under the curve 0.747, 90% confidence interval 0.613-0.881, p=0.023). Conclusion: Aortic wrapping could be considered as a safe and long-term therapeutic option. Redilation of the proximal arch should be carefully observed during long-term follow-up.
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Kim et al. (2019) conducted a cohort in Ascending aortic dilation (n=96). Aortic wrapping during aortic valve replacement was evaluated on Freedom from adverse aortic events (aortic dissection or rupture, reoperation, or sudden death) at 10 years. Aortic wrapping during aortic valve replacement in patients with moderate ascending aortic dilation resulted in a 97.9% freedom from adverse aortic events at 10 years, though significant redilation occurred at the proximal aortic arch.
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