Is reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether reduction aortoplasty is an acceptable alternative to ascending aorta replacement. From 925 potential papers, 13 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that aortoplasty seems to be a safe procedure which gives good postoperative outcomes in selected patients. Our literature review documents 716 patients from 13 papers, with only 25 patients that on follow-up suffered redilatation (3%). Thus, reduction aortoplasty is a viable alternative to conventional aortic root replacement or interposition tube grafting in some patients. In particular, an aortoplasty in elderly patients with post-stenotic dilatation, or in patients with significant co-morbidities is attractive. It should be acknowledged that only one study directly compares the technique with conventional replacement and that replacement remains the 'gold standard' technique. It should also be acknowledged that the external wrap is not without risk and wrap dislocation, erosion or fistula formation are recognised complications.