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Concomitant Wrapping of a Moderately Dilated Ascending Aorta during Aortic Valve Replacement: Postoperative Remodeling of a Distinctive Aorta

 Hyo Hyun Kim  ;  Sak Lee  ;  Seung Hyun Lee  ;  Byung Chul Chang  ;  Young Nam Youn  ;  Kyung Jong Yoo  ;  Hyun Chel Joo 
 YONSEI MEDICAL JOURNAL, Vol.61(1) : 40-47, 2020-01 
Journal Title
Issue Date
Aorta, Thoracic / surgery* ; Aortic Diseases / surgery ; Aortic Valve / surgery* ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation* ; Humans ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Period ; ROC Curve ; Retrospective Studies ; Sinus of Valsalva / surgery ; Treatment Outcome
Aortic aneurysm ; aorta ; aortic valve
Purpose: The long-term outcomes of aortic wrapping in patients with ascending aortic aneurysms, which are rare, but can be fatal, remain poorly understood. This retrospective study analyzed the outcomes of aortic diameter, including aortic root, ascending aorta, and proximal arch diameters, after aortic wrapping during aortic valve replacement surgery. Materials and methods: Ninety-six patients with ascending aortic dilation of 40-55 mm who underwent aortic wrapping during aortic valve replacement were selected for this study. Aortic diameter was measured at three levels perioperatively and at follow-up (median time of 9.1±4.2 years). A linear mixed-effects model was used to analyze aortic diameter expansion. Results: Freedom from adverse aortic events (aortic dissection or rupture, reoperation, or sudden death) at 10 years was 97.9%. No significant dilation at the level of the sinuses of Valsalva (0.069 mm/year, p=0.524) or ascending aorta (0.152 mm/year, p=0.124) was observed. Significant dilation occurred at the proximal aortic arch (0.343 mm/year, p=0.006). Subgroup analysis with a multivariable linear mixed model identified initial ascending aortic diameter to be a significant predictor of proximal arch dilation (p=0.032). Receiver operating characteristic curve analysis revealed that the cut-off for the prediction of proximal arch redilation was an initial mid-ascending aortic diameter of 47.0 mm (area under the curve 0.747, 90% confidence interval 0.613-0.881, p=0.023). Conclusion: Aortic wrapping could be considered as a safe and long-term therapeutic option. Redilation of the proximal arch should be carefully observed during long-term follow-up.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyohyun(김효현) ORCID logo https://orcid.org/0000-0002-1608-9674
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Chang, Byung Chul(장병철)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
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