JTCS Concomitant Website
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sievers, H. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sievers, H. H.

J Thorac Cardiovasc Surg 2004;128:499-501
© 2004 The American Association for Thoracic Surgery

Editorial

Reflections on reduction ascending aortoplasty's liveliness

Hans H. Sievers, MD*

Department for Cardiac Surgery, University of Schleswig-Holstein, Campus Luebeck, Department for Cardiac Surgery, Luebeck, Germany

Received for publication May 26, 2004; accepted for publication June 2, 2004.

* Address for reprints: Hans H. Sievers, MD, Chief of Department for Cardiac Surgery, University of Schleswig-Holstein, Campus Luebeck, Department for Cardiac Surgery, Ratzeburger Alle 160, Luebeck, Germany D-23538 (E-mail: herzchir@medinf.mu-luebeck.de).

The first 20% of the full text of this article appears below.

Reduction ascending aortoplasty (RAA) is alive, but the real question is whether it should be. Dr Robicsek and colleagues1 deserve a lot of credit for renewing the discussion on the appropriate treatment of ascending aortic dilatation–aneurysm. To evaluate RAA's inevitably requires examining the problem of decision making. This is influenced by many factors used to balance the risk and benefit of nonsurgical versus surgical treatment. The risk of the nonsurgical natural course is predominantly determined by the development of aneurysm, as well as by morbidity and mortality caused by dissection and rupture.2 The main actors of these events are the wall tension, as calculated by Laplace's law, including pressure, size, and wall thickness, and, furthermore, wall pathology (genetic collagen disorders, chronic dissection, sex, aging, degeneration, and arteriosclerosis), hemodynamic load caused by aortic valve pathology, concomitant aortic valve replacement, and the growth rate of the dilatation. The benefit of the nonsurgical natural course is that those who would never experience the above detrimental events would experience neither its related morbidity and mortality nor the risks of surgical intervention. The risks of surgical intervention are well known, and the benefits are associated with the type of intervention; they are, briefly, total eradication of diseased tissue with a tube graft, reduction of size by RAA, and external reinforcement by wrapping. In addition to all these parameters, life expectancy and individual experience of the surgeon contribute to decision making. Not all of these factors are equally important or easily quantified, but the size of the ascending aorta together with aortic wall morphology are the most important and currently used determinants.

The size of the ascending aorta depends on, among other factors, body surface area (BSA) and, . . . [Full Text of this Article]






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2004 by The American Association for Thoracic Surgery.