Long-term fate of the ascending aortic wall after wrapping with polytetrafluoroethylene felt: A case series

Abstract Background: Aortic wrapping aims to prevent aortic enlargement or dissection; it is less invasive than ascending aorta replacement. Several studies have reported low mortality and morbidity rates in patients treated using aortic wrapping. Wrapping is often accompanied by aortic valve replacement, which may require a redo surgery after some years. However, only few reports have focused on the redo surgery after aortic wrapping. We report three such cases of redo surgery in patients who previously underwent aortic wrapping using polytetrafluoroethylene felt.Case presentation: Among the three cases, two were referred with complaints associated with the deterioration of the prosthetic valve, 10 years or longer after the initial surgery. In all the cases, the aortic wall exhibited severe erosion, necessitating replacement of the ascending aorta.Conclusion: The portion of the ascending aortic wall wrapped with polytetrafluoroethylene felt exhibited severe erosion late after surgery. Therefore, ascending aorta graft replacement is highly likely to be necessary in redo surgery performed long after initial ascending aorta wrapping.

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Old Myths, New Concerns: the Long-Term Effects of Ascending Aorta Replacement with Dacron Grafts. Not All That Glitters Is Gold

Journal of Cardiovascular Translational Research ◽

10.1007/s12265-016-9699-8 ◽

2016 ◽

Vol 9 (4) ◽

pp. 334-342 ◽

Cited By ~ 37

Author(s):

Cristiano Spadaccio ◽

Francesco Nappi ◽

Nawwar Al-Attar ◽

Fraser W. Sutherland ◽

Christophe Acar ◽

...

Keyword(s):

Ascending Aorta ◽

Long Term Effects ◽

Aorta Replacement ◽

Ascending Aorta Replacement

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Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2015.10.113 ◽

2016 ◽

Vol 151 (3) ◽

pp. 764-774.e4 ◽

Cited By ~ 38

Author(s):

Lars G. Svensson ◽

Saila T. Pillai ◽

Jeevanantham Rajeswaran ◽

Milind Y. Desai ◽

Brian Griffin ◽

...

Keyword(s):

Aortic Root ◽

Ascending Aorta ◽

Term Survival ◽

Long Term Survival ◽

Aorta Replacement ◽

Ascending Aorta Replacement

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Partial Clamping of the Brachiocephalic Trunk for Total Ascending Aorta Replacement without Circulatory Arrest: Early and Midterm Results

The Heart Surgery Forum ◽

10.1532/hsf98.20041020 ◽

2004 ◽

Vol 7 (3) ◽

pp. E201-E207

Author(s):

Antonio Maria Calafiore ◽

Michele Di Mauro ◽

Carlos-A. Mestres ◽

Gabriele Di Giammarco ◽

Giovanni Teodori ◽

...

Keyword(s):

Circulatory Arrest ◽

Ascending Aorta ◽

Midterm Results ◽

Brachiocephalic Trunk ◽

Aorta Replacement ◽

Ascending Aorta Replacement

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Intravascular Ultrasound Findings of BioGlue Surgical Adhesive Coronary Embolism After Ascending Aorta Replacement

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2020.11.018 ◽

2021 ◽

Vol 14 (4) ◽

pp. e39-e41

Author(s):

Masashi Yokoi ◽

Hiroshi Fujita ◽

Tatsuhito Ogawa ◽

Tsuyoshi Ito ◽

Yoshihiro Seo ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Ascending Aorta ◽

Surgical Adhesive ◽

Ultrasound Findings ◽

Aorta Replacement ◽

Coronary Embolism ◽

Ascending Aorta Replacement

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Early safety performance of a modified technique of aorta replacement with sinotubular stabilization

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211015094 ◽

2021 ◽

pp. 021849232110150

Author(s):

Marco Moscarelli ◽

Nicola Di Bari ◽

Giuseppe Nasso ◽

Khalil Fattouch ◽

Thanos Athanasiou ◽

...

Keyword(s):

Artery Bypass ◽

Aortic Insufficiency ◽

Ascending Aorta ◽

Safety Performance ◽

Modified Technique ◽

Sinotubular Junction ◽

Aorta Replacement ◽

Valve Sparing ◽

Ascending Aorta Replacement

Background We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. Methods This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dilatation of the ascending aorta, normal sinuses of Valsalva dimension (<45 mm), with or without aortic annulus enlargement (>25 mm) and with various degree of aortic insufficiency (from grade 1 to 3). Results From April to October 2019, 20 patients were recruited from two centers; mean age was 66.9 ± 12.8 years, 13 were male; grade 1, 2 and 3 was present in 12, 2 and 6 patients, respectively. All patients underwent ascending aorta replacement with modified technique; an additional open subvalvular ring was used in 8 patients with aortic insufficiency ≥ 2; cusps repair was performed in 6 patients (5 plicating central stitches/1 shaving); concomitant coronary artery bypass grafting was performed in 10 patients. There was no 30-day mortality. One patient was re-explored for bleeding. All patients completed six-month follow-up; at the transthoracic echocardiography, there was no aortic insufficiency ≥ 1 except one patient with aortic insufficiency grade 1 who underwent ascending aorta replacement and subvalvular ring; no patients underwent reintervention. Conclusions This modified technique for ascending aorta replacement and sinotubular junction stabilization was safe. It could be associated with other aortic valve sparing techniques. However, such remodeling approach has to be validated in a larger cohort of patients with longer follow-up.

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Fate of mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement

10.22541/au.160901985.50675267/v1 ◽

2020 ◽

Author(s):

Alessandro Verzini ◽

Marta Bargagna ◽

Guido Ascione ◽

Alessandra Sala ◽

Davide Carino ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Term Survival ◽

Kaplan Meier ◽

Aortic Root Surgery ◽

Increased Risk ◽

Aorta Replacement ◽

Ascending Aorta Replacement

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (± mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyze. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max 16.4). Kaplan Meier estimates were employed to analyze long-term survival. Cumulative incidence function for time to re-operation, recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63]. At follow-up there were no cases of aortic root surgery whereas 3 patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR>2+/4+ was 5.1±4.98% and of AS>moderate 6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a BAV did not significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.

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