Ann Thorac Surg 2004;78:386-387
© 2004 The Society of Thoracic Surgeons
Correspondence
How to avoid problems with reduction aortoplasty
Sinan Arsan, MD
Department of Cardiovascular Surgery, University of Maltepe, School of Medicine, Ataturk Cad. Cam Sk. No 3/A, 81530 Maltepe, Istanbul, Turkey
e-mail: arsans{at}ixir.com
To the Editor:
I read with interest the case report by Bauer and colleagues [1]. It clearly shows that using an external tubular Dacron graft for reduction aortoplasty, which is favored for its short- and long-term durability, can result in disaster if some rules are not respected. I believe that the problems encountered in reduction aortoplasty with external wrapping are due mostly to the aortoplasty technique during wrapping. Although there are several surgical techniques for reduction aortoplasty [2, 3], I routinely prefer the external wrapping technique without incising or excising of the diseased aorta ("sandwich technique"). The sandwich technique prevents complications and can be performed easily, even on the beating heart (off-pump) in select patients (Fig 1).
In this procedure, the Dacron tube graft is tailored to the diseased aorta longitudinally using separate, full-thickness U sutures.
View larger version (43K):
[in this window]
[in a new window]
|
Fig 1. Operative technique for external wrapping. (A) Broken vertical lines on the diseased aorta indicate the planned full-thickness suture lines for creating the desired aortic diameter, preventing a textured intimal surface, and immobilizing the external graft. (B) Wrapped aorta.
|
|
I have performed 66 such operations with no late cardiac-related mortality or morbidity. Four of the procedures were performed off-pump. Making a decision regarding a dilated ascending aorta during a coronary bypass operation is sometimes difficult because of the relatively high mortality and morbidity rates associated with replacement. This is especially true in patients with severe cardiac or noncardiac disease in whom prolonged cardiopulmonary bypass and aortic cross-clamp times cannot be tolerated [4, 5]. In such instances, external wrapping on-pump or off-pump is a strong alternative to replacement.
See page 317
References
- Bauer M., Grauhan O., Hetzer R. Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta. Ann Thorac Surg 2003;75:583-584.[Abstract/Free Full Text]
- Baumgartner F., Omari B., Pak S., Ginzton L., Shapiro S., Milliken J. Reduction aortoplasty for moderately sized ascending aortic aneurysms. J Card Surg 1998;13:129-132.[Medline]
- Robicsek F. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: an alternative to radical resection. Ann Thorac Surg 1982;34:92-94.[Abstract]
- Crawford E.S., Svensson L.G., Coselli J.S., Safi H.J., Hess K.R. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch: factors influencing survival in 717 patients. J Thorac Cardiovasc Surg 1989;98:659-674.[Abstract]
- Bauer M., Pasic M., Schaffarzyk R., et al. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg 2002;73:720-724.[Abstract/Free Full Text]
