WRAPPING OF THE MODERATELY DILATED ASCENDING AORTA BY FRESH AUTOLOGOUS
Background and aim of the study. Wrapping of the ascending
aorta (AA), isolated or associated with aortoplasty, has never been
completely accepted. Some complications, as folding of the aortic wall,
compression of the vasa vasorum and changes in the flow pattern, with
consequent dilatation of the proximal arch, have been described. We used
fresh autologous pericardium (FAP), so far never reported, to wrap the
AA, with the aim to stabilize its size when moderately dilated,
maintaining the preoperative dimension or limiting the reduction to a
few mm. Material and Methods. From 2015 to 2019, 10 patients,
who were operated on for valve or coronary surgery or both, underwent
wrapping of the AA with FAP. Mean age was 69±7 years and ESII 3.5±1.7.
Four patients had moderately impaired ejection fraction (35-49%).
Results. There was no early or late mortality. One patient was
reoperated on after 48 months for severe mitral regurgitation. At a
follow up of 53±14 months, a transthoracic echocardiogram showed that
the AA size reduced slightly but significantly, from 45.2±2.0 to
42.5±4.1 mm, p=0.03. The diameter of the proximal arch remained
unchanged, from 37.1±1.6 to 36.3±2.9 mm, p=0.20. Conclusions.
In presence of moderately dilated AA wrapping can be a reasonable
option. The use of FAP stabilizes the size of the aorta after a follow
up of 53 months. Maintaining a size similar to the preoperative one
avoids the complications related to the procedure.