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

Abstract

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. 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±7.4years) underwent ascending aorta wrapping (n=96) or replacement (n=108) for a moderately dilated ascending aorta (40 to 55mm). The overall fate of the aortic diameter was analyzed with a linear mixed-effect model. The median follow-up duration was 7.1years. After propensity score matching, the baseline maximal ascending aortic diameter median value was 47.3±3.1mm and 49.4±13.5mm 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 (0.343mm/year; P=.006) in the wrapping group but not in the replacement group (0.066mm/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 47.2mm for the prediction proximal arch redilation (area under the curve, 0.703; P=.014). 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.