Surgical Correction of Ascending Aortic Aneurysm and Aortic Valve Incompetence by Relocation of the Aortic Valve Plane Using a Short Aortic Replacement Graft

• Published in: The Annals of thoracic surgery Vol. 94; no. 6; pp. 1983 - 1989
• Main Authors: Hetzer, Roland, MD, PhD, Solowjowa, Natalia, MD, Knosalla, Christoph, MD, PhD, Kuckuka, Marian, MD, Delmo Walter, Eva Maria B., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta, Thoracic - transplantation; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - surgery; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Cardiology. Vascular system; Cardiothoracic Surgery; Child; Diseases of the aorta; Echocardiography; Female; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Medical sciences; Middle Aged; Pneumology; Prosthesis Design; Retrospective Studies; Surgery; Suture Techniques; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Young Adult; 26; Corrective surgery; Treatment; Cardiovascular disease; Anesthesia; Aorta; Graft; Replacement; Circulatory system; Cardiology; Aortic aneurysm; Aortic valve
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.07.043

Background Ascending aortic aneurysms grow circumferentially and longitudinally. This geometric dislocation with widening, flattening, or loss of the sinotubular junction by aortic dilatation distorts and causes incompetence of even a structurally normal valve. We described a technique of surgical correction of ascending aortic aneurysm and valve incompetence by relocating the displaced aortic annulus plane to its normal anatomic position. Methods Between 1998 and 2011, 48 patients (median age, 66.5; range, 7 to 82 years) with ascending aortic aneurysm and elongation and severe aortic valve incompetence underwent ascending aortic replacement. The aneurysm was incised longitudinally, and an appropriately sized straight Dacron (DuPont, Wilmington, DE) graft was sutured onto the aorta approximately 5 mm above the commissures, recreating the sinotubular junction. When valve competence was assured, the graft, cut considerably shorter than the original length of the ascending aorta, was anastomosed distally. The valve plane was hence relocated in a more cranial/oblique position, restoring its normal alignment. Perioperative echocardiographic and computed tomography studies were done to document the degree of aortic valve incompetence and the morphology of the aortic root. Results During a mean follow-up of 3.0 ± 2.7 years, aortic insufficiency was absent to trivial in 34, mild in 12, and moderate in 2 patients. Postoperative computed tomography showed considerable aortic shortening, remarkable sinotubular junction narrowing, aortic root diameter reduction, and angular widening between the aortic root plane and longitudinal spinal axis corresponding to aortic incompetence reduction. Conclusions Aortic relocation technique provided satisfactory results in management of ascending aortic aneurysm and elongation with aortic valve incompetence.