Tomasz Plonek1. 1. Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland.
Abstract
BACKGROUND: One of the methods of dealing with a dilated ascending aorta is to decrease its diameter using external wrapping. This exovascular procedure is regarded by many surgeons as controversial. The aim of the study was to evaluate the safety and efficacy of external wrapping of the ascending aorta. METHODS: A metaanalysis and systematic review of studies reporting mid-term and long-term results of wrapping of the ascending aorta were performed. The postoperative hospital mortality, aortic-related mortality, significant redilatation rate, and need for aortic reoperation were analyzed. RESULTS: 17 manuscripts were included in the final analysis and postoperative data of 722 patients were studied. The mean age of patients was 58 years and mean follow-up was 62 months. Hospital mortality was 1.5% (11 deaths). During the follow-up late aortic related mortality was noted in two patients (0.3%), there were 12 (1.7%) cases of significant redilatation of the ascending aorta, and 13 (1.8%) patients had to have their ascending aorta reoperated. All of the aortic complications were noted in patients who either did not have their external wrapping sutured to the aorta or who underwent concomitant aortoplasty. CONCLUSIONS: The results of the metaanalysis suggest that external aortic wrapping may be considered as a safe operative technique. In patients with a moderately dilated aorta it offers good mid-term and long-term outcome compared to replacement of the ascending aorta.
BACKGROUND: One of the methods of dealing with a dilated ascending aorta is to decrease its diameter using external wrapping. This exovascular procedure is regarded by many surgeons as controversial. The aim of the study was to evaluate the safety and efficacy of external wrapping of the ascending aorta. METHODS: A metaanalysis and systematic review of studies reporting mid-term and long-term results of wrapping of the ascending aorta were performed. The postoperative hospital mortality, aortic-related mortality, significant redilatation rate, and need for aortic reoperation were analyzed. RESULTS: 17 manuscripts were included in the final analysis and postoperative data of 722 patients were studied. The mean age of patients was 58 years and mean follow-up was 62 months. Hospital mortality was 1.5% (11 deaths). During the follow-up late aortic related mortality was noted in two patients (0.3%), there were 12 (1.7%) cases of significant redilatation of the ascending aorta, and 13 (1.8%) patients had to have their ascending aorta reoperated. All of the aortic complications were noted in patients who either did not have their external wrapping sutured to the aorta or who underwent concomitant aortoplasty. CONCLUSIONS: The results of the metaanalysis suggest that external aortic wrapping may be considered as a safe operative technique. In patients with a moderately dilated aorta it offers good mid-term and long-term outcome compared to replacement of the ascending aorta.