What is the clinical evidence from this study?

Study design: Cohort. Population: Bicuspid aortic stenosis with dilated ascending aorta (n=223). Intervention: Ascending aortic wrapping vs. Aortic valve replacement alone. Primary outcome: 10-year overall survival (p=0.048).

What does this research mean for the field?

Ascending aortic wrapping during aortic valve replacement for bicuspid aortic stenosis results in higher 10-year overall survival compared to AVR alone, with no late aortic complications. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

January 1, 2015Open Access

Aortic Wrapping for a Dilated Ascending Aorta in Bicuspid Aortic Stenosis

MCMin Suk ChoiDongguk University Ilsan Hospital DJDong Seop JeongSamsung Medical Center HLHae Young LeeCheongju University

Key Result

Ascending aortic wrapping during AVR for bicuspid aortic stenosis resulted in higher 10-year overall survival compared to AVR alone (88.1% vs. 80.0%, P=0.048), with no late aortic complications.

Study Design

Type

Cohort (n=223)

Structured PICO

Does ascending aortic wrapping improve long-term survival and prevent complications in patients with a dilated ascending aorta undergoing AVR for bicuspid aortic stenosis?

Population

223 patients who underwent primary aortic valve replacement (AVR) for bicuspid aortic stenosis (BAS) between 2002 and 2011, including those with a dilated ascending aorta.

Intervention

Ascending aortic wrapping transversely with a semi-elliptically resected Dacron graft at the time of aortic valve replacement (AVR).

Comparator

Aortic valve replacement (AVR) alone.

Outcome

Early and late outcomes, including overall survival, morbidity, and late aortic complications.hard clinical

Aortic wrapping with a Dacron graft during AVR for bicuspid aortic stenosis is a safe and effective option for managing a moderately dilated ascending aorta, associated with excellent 10-year survival and no late aortic complications.

Main Result

Absolute Event Rate: 88.1% vs 80%

p-value: p=0.048

Limitations

Longer follow-up is necessary to verify later complications

Abstract

BACKGROUND: Ascending aorta wrapping is rarely recommended for the management of dilated aorta, because of late complications. The aim of the present study was to analyze the early and late outcomes of the aortic wrapping technique at the time of aortic valve replacement (AVR) for bicuspid aortic stenosis (BAS). METHODS AND RESULTS: Among patients who underwent primary AVR for BAS between 2002 and 2011, 79 who underwent ascending aortic wrapping (wrapping group) were compared with 144 patients who underwent AVR alone. The preoperative ascending aortic diameters were larger in the wrapping group (40.9±4.2 mm vs. 48.6±4.0 mm, P<0.001). Operative technique was to wrap the ascending aorta transversely with a semi-elliptically resected Dacron graft. The follow-up for the wrapping group was 76.5±35.5 (median 71.1) months. There were no early deaths. Early and late morbidity did not differ between groups. The 24 late deaths, including 10 cardiac-related deaths, occurred in the entire group; 3 sudden deaths occurred only in the AVR group. The 10-year overall survival in the wrapping group was higher than the AVR group (88.1±6.8% vs. 80.0±4.6%, P=0.048). No late aortic complications were detected. The aortic diameter was reduced from 49.5±4.1 mm to 45.3±5.0 mm after wrapping (P<0.001). CONCLUSIONS: The aortic wrapping technique may be an option for treating a moderately dilated ascending aorta in selected patients undergoing AVR for BAS. Longer follow-up, however, is necessary to verify later complications.

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