An alternate solution for the treatment of ascending aortic aneurysms: the wrapping technique
© Tagarakis et al; licensee BioMed Central Ltd. 2010
Received: 3 September 2010
Accepted: 3 November 2010
Published: 3 November 2010
The aortic Dacron wrapping technique is a surgical technique used under certain circumstances in cases of ascending aorta dilatation. Herein, we are presenting our experience on the method performed on multimorbid patients who denied major aortic surgery.
We included in our series 7 patients (5 male-2 female) with mild to moderate ascending aortic dilatation, who were operated with the wrapping technique. One patient was submitted to biological aortic valve replacement during the same procedure. The number of conventionally operated patients during the same period (2 years) was 21.
Mortality during the 18-months follow-up control was 0%. One patient had to be operated with biological aortic valve replacement 18 months after the initial wrapping operation, although the diameter of her ascending aorta remained stable.
The Dacron wrapping technique is a method that can alternatively be used in multimorbid patients with mild to moderate ascending aortic dilatation without dissecting elements and has generally good results.
Letter to the Editor
Patients' baseline characteristics and comorbidities
Aortic valve insufficiency/indication for surgical repair or replacement
Ascending aortic diameter
Mild to moderate, aortic valve replacement performed
Diabetes mellitus, arterial hypertension, renal failure,
Diabetes mellitus, arterial hypertension, adipositas per magna, heart failure (left ventricular ejection fraction 45%)
Diabetes mellitus, arterial hypertension, renal failure (dialysis), previous CABG
Diabetes mellitus, arterial hypertension, coronary artery disease, previous CABG
Diabetes mellitus, arterial hypertension, hyperlipidemia, coronary artery disease, heart failure, left ventricular ejection fraction 30%)
Arterial hypertension , chronic obstructive pulmonary disease, adipositas per magna
Arterial hypertension, previous CABG, chronic obstructive pulmonary disease
Intra-and perioperative mortality was 0%. In the 18 months' follow-up control none of the patients presented with augmented ascending aortic diameter (as measured per echocardiography and CT angiography). Patient No 2 developed progressive aortic valve insufficiency (with stable aortic diameter), and was submitted to successful biological aortic valve replacement 18 months after the initial operation.
In regard to the issue of neurological and neuropsychiatric complications (stroke, transient ischemic attacks, postoperative delirium), which can consist a major problem after aortic surgery, we are glad to report that no incidents of the kind were observed.
In conclusion, the Dacron wrapping technique can be an alternative solution for ascending aortic aneurysms without dissecting elements in cases of severely morbid patients who are unwilling to undergo major aortic surgery due to the significantly increased perioperative risk. We would however wish to emphasize that this technique should not be misused as a standard procedure in cases of ascending aortic dilatation, but adopted only in exceptional cases where mild to moderate dilatation, advanced age and major comorbidities are combined with the patient's wish to avoid major aortic surgery.
Conflicts of interest
The authors declare that there are no conflicts of interest.
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