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Less Invasive Approach to the Patients Undergoing AVR with Moderately Enlarged Ascending Aorta; PTFE Felt Wrapping Surgery
Makoto Hibino, Kazuyoshi Tajima, Ken-ichiro Uchida, Hisaaki Munakata, Kei Fujii, Wataru Kato, Yoshiyuki Takami, Yoshimasa Sakai.
Nagoya Daini Rescross Hospital, Nagoya, Japan.

OBJECTIVE: To prevent the post AVR aortic event, the concomitant ascending aortic surgery is recommend to the patient with more than 50mm in tricuspid aortic valve. There are dilemmas about the increase of the operative risk by the replacement of ascending aorta and the future risk of ascending aortic enlargement by leaving the moderately enlarged ascending aorta untreated. There are many reports of less invasive ascending aortic surgery to reduce the risk of the operation and future enlargement, such as ascending aortoplasty and ascending aortic wrapping with kinds of materials. For this purpose, we have performed ascending aortic PTFE felt wrapping to the patients undergoing AVR with moderately enlarged ascending aorta. To testify the efficacy of our approach, we hereby report our long term results.
METHODS: Between January 2005 and September 2011 at our single institute, we performed ascending aortic PTFE felt wrapping surgery to 9 patients from 312 patients undergoing cardiac surgery including AVR. Computed tomography scan of the ascending aorta was performed in the preoperative, early and late postoperative term. Dates were analyzed retrospectively. PTFE felt wrapping was performed after AVR was performed and the hemostasis of the ascending aorta was confirmed. PTFE felt (15×15cm) was trimmed into a butterfly shape to fit the ascending aortic curvature.
RESULTS: The mean age was 68.7±7.6years(range, 57to77). The overall aortic valvular diseases we treated were: 2 aortic insufficiency, 6 aortic stenosis, 1 aortic stenosis and insufficiency and 6 bicuspid aortic valve. There was no hospital death, no morbidity and no postoperative aortic events. The mean interval of the follow-up CT scans was 2.4 years (range, 0.03 to 5.69). The diameters of the ascending aorta were significantly reduced from mean 46.9±3.3mm (range, 43 to 54) to mean 39.6±5.6mm(range, 29 to 46) in late term(P=0.0077). There was no enlargement in the proximal and distal portion of the felt wrapping.
CONCLUSIONS: The PTFE felt wrapping surgery given to the patients undergoing AVR with moderately enlarged ascending aorta is useful to reduce the diameter, and to prevent future enlargement less invasively.


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