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The long-term fate of ascending aorta aneurysm after wrapping versus replacement

Authors
 Hyo-Hyun Kim  ;  Sak Lee  ;  Seung Hyun Lee  ;  Young-Nam Youn  ;  Kyung-Jong Yoo  ;  Hyun-Chel Joo 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.164(2) : 463-474, 2022-08 
Journal Title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN
 0022-5223 
Issue Date
2022-08
MeSH
Aged ; Aorta / diagnostic imaging ; Aorta / surgery ; Aortic Aneurysm* / diagnostic imaging ; Aortic Aneurysm* / surgery ; Aortic Valve / diagnostic imaging ; Aortic Valve / surgery ; Dilatation, Pathologic / surgery ; Humans ; Middle Aged ; Retrospective Studies ; Treatment Outcome
Keywords
aortic aneurysm ; aortic replacement ; aortic valve replacement ; aortic wrapping ; ascending aorta
Abstract
Objective: The study objective was to examine the long-term fate of aortic diameter expansion at 4 cardiac regions (annulus, sinus, ascending aorta, and proximal arch) after wrapping or replacement during aortic valve surgery of the moderately dilated ascending aorta.

Methods: From January 1995 to December 2018, 964 consecutive patients who underwent aortic valve replacement at our institution were reviewed. Of them, 204 (mean age, 60.7 ± 7.4 years) underwent ascending aorta wrapping (n = 96) or replacement (n = 108) for a moderately dilated ascending aorta (40 to 55 mm). The overall fate of the aortic diameter was analyzed with a linear mixed-effect model. The median follow-up duration was 7.1 years.

Results: After propensity score matching, the baseline maximal ascending aortic diameter median value was 47.3 ± 3.1 mm and 49.4 ± 13.5 mm in the wrapping and replacement groups, respectively. The annulus, sinus, and ascending aorta did not redilate in either group. The proximal aortic arch diameter significantly increased over time (0.343 mm/year; P = .006) in the wrapping group but not in the replacement group (0.066 mm/year; P = .649). Multivariable competing risk analysis identified the initial ascending aorta diameter at the wrapping procedure as an independent risk factor of proximal arch redilation (0.071 ± 0.037, P < .001). The cutoff value was an initial ascending aorta diameter of 47.2 mm for the prediction proximal arch redilation (area under the curve, 0.703; P = .014).

Conclusions: Aortic wrapping and replacement may be long-term durable treatment options in patients with a moderately enlarged ascending aorta. We suggest careful evaluation of redilation in the proximal arch after an aorta wrapping procedure.
Files in This Item:
T202202768.pdf Download
DOI
10.1016/j.jtcvs.2020.12.110
Appears in Collections:
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
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/189498
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