HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Francis Robicsek Joseph W. Cook Mark K. Reames, Sr Eric R. Skipper Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Robicsek, F. Articles by Skipper, E. R. Search for Related Content PubMed PubMed Citation Articles by Robicsek, F. Articles by Skipper, E. R. Related Collections Cardiac - other

J Thorac Cardiovasc Surg 2004;128:562-570
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Size reduction ascending aortoplasty: Is it dead or alive?

^a Department of Thoracic and Cardiovascular Surgery and Heineman Medical Research Laboratories at Carolinas Medical Center, Charlotte, NC, USA

Received for publication December 2, 2003; revisions received February 17, 2004; accepted for publication April 19, 2004.

^* Address for reprints: Francis Robicsek, MD, PhD, 1001 Blythe Blvd, Suite 300, Charlotte, NC 28203, USA
frobicsek{at}sanger-clinic.com

OBJECTIVE: Reduction ascending aortoplasty is a controversial procedure. Some believe that it can be appropriately applied when the anatomic features are favorable. Others suggest that it should be restricted to those patients who are at unacceptably high risk for more radical procedures, and there are also those who believe that reduction ascending aortoplasty should not be applied at all. The purpose of the article is to draw conclusions on the applicability of reduction ascending aortoplasty in modern cardiovascular surgery.

METHODS: The issue was examined in the mirror of the authors' own experiences, by review and scrutiny of the literature available on the subject, and by conducting an extensive survey of the profession.

RESULTS: We found that given proper indications (ie, poststenotic dilatations of <6 cm in diameter, absence of cystic medial necrosis, and a technique that decreases aortic diameter to <3.5 cm), nonreinforced reduction ascending aortoplasty performed concomitantly with aortic valve replacement appears to be a simple and safe procedure, with low morbidity and mortality and rare late complications. External reinforcement might extend the scope of indication for reduction ascending aortoplasty to ascending aortic aneurysms associated with aortic regurgitation and to those with primary structural aortic wall disease with comparable results. Experience also has shown that late complications might be further reduced by means of proper proximal anchoring and extending the wrap past the origin of the innominate artery.

CONCLUSIONS: We conclude that reduction ascending aortoplasty is certainly alive. Although it does not appear to be an extremely popular operation, about half of the surgeons who responded believe it to be justified. Regardless of which modality is used, lifetime monitoring of ascending aortic size is essential and so advised. Because of recent sporadic reports of "under-the-wrap" aortic wall atrophy and rupture, the issue of reinforcement of reduction ascending aortoplasty requires continued re-evaluation.

This article has been cited by other articles:

				M. Gill and J. Dunning Is reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta? Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 693 - 697. [Abstract] [Full Text] [PDF]

				P. J. Hess Jr, P. K. Harman, C. T. Klodell, T. M. Beaver, M. T. Bologna, P. Mikhail, C. G. Tribble, and T. D. Martin Early Outcomes Using the Florida Sleeve Repair for Correction of Aortic Insufficiency due to Root Aneurysms Ann. Thorac. Surg., April 1, 2009; 87(4): 1161 - 1169. [Abstract] [Full Text] [PDF]

				I. V Belov, A. B Stepanenko, A. P Gens, D. D Savichev, and E. R Charchyan Reduction Aortoplasty for Ascending Aortic Aneurysm: a 14-Year Experience Asian Cardiovasc Thorac Ann, April 1, 2009; 17(2): 162 - 166. [Abstract] [Full Text] [PDF]

				J. Litmathe and P. Feindt Reply to Apostolakis et al. Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 684 - 684. [Full Text] [PDF]

				J. Litmathe and P. Feindt Reply to Yavuz Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 555 - 555. [Full Text] [PDF]

				A. John, B. Al-Hariri, J. Ackemann, and H. Warnecke Replacing the diseased aortic valve and the proximal aorta in the elderly patient Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 939 - 940. [Abstract] [Full Text] [PDF]

				P. Feindt, J. Litmathe, A. Borgens, U. Boeken, M. Kurt, and E. Gams Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery? Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 614 - 617. [Abstract] [Full Text] [PDF]

				T. Walker, D. H.L. Bail, M. Gruler, R. Vonthein, V. Steger, and G. Ziemer Unsupported Reduction Ascending Aortoplasty: Fate of Diameter and of Windkessel Function Ann. Thorac. Surg., March 1, 2007; 83(3): 1047 - 1053. [Abstract] [Full Text] [PDF]

				T. Sundt III Invited commentary Ann. Thorac. Surg., March 1, 2007; 83(3): 1053 - 1054. [Full Text] [PDF]

				K. Matsuyama, M. Yoshikawa, Y. Narita, and Y. Ueda The Sock Method for a Distal Ascending Aneurysm Asian Cardiovasc Thorac Ann, February 1, 2007; 15(1): 72 - 73. [Abstract] [Full Text] [PDF]

				G. Polvani, F. Barili, L. Dainese, V. K. Topkara, F. H. Cheema, E. Penza, S. Ferrarese, A. Parolari, F. Alamanni, and P. Biglioli Reduction Ascending Aortoplasty: Midterm Follow-Up and Predictors of Redilatation Ann. Thorac. Surg., August 1, 2006; 82(2): 586 - 591. [Abstract] [Full Text] [PDF]