Wrapping of the ascending aorta: history and prospects

Abstract

Historically, exoprosthetics is one of the first surgical procedures used for aneurysmal dilatation of such great vessels as the aorta. Despite the acceptable results of this method it is not widespread now because of the possible negative consequences of aortic wall wrapping (rupture or dissection). According to the latest guidelines, it is necessary to consider prosthetics of the ascending aorta by the patients with aortic valve surgery and aneurysmal dilatation of the ascending aorta more than 45 mm. However, early postoperative mortality reaches 20 % by elderly patients with severe comorbidities. In such situations, it is worth to choose a less traumatic surgical approach. Exoprosthetics of the aorta reduces the invasiveness of procedure, time of artificial circulation and aortic occlusion thereby taking down the risks of early postoperative complications. The purpose of this literature review is to analyze the current data on the technique of exoprosthetics of the aorta by the patients with moderate ascending aorta dilatation. The Scopus, Web of Science, PubMed databases were used for searching and selecting literature sources. The results demonstrate that aortic wrapping is a safe method causing rapid and permanent aortic remodeling. The technique has comparable long-term results with prosthetics of the ascending aorta despite the presence of histological changes in the aortic wall with a changing in its mechanical properties. Received 28 September 2021. Revised 19 January 2022. Accepted 20 January 2022. Funding: This work was carried out within the framework of the state task of Ministry of Health of Russian Federation No. 121032300337-5. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: S.A. Alsov, D.A. SirotaDrafting the article: V.A. AkulovCritical revision of the article: S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: V.A. Akulov, S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. Chernyavskiy