Reduction plasty for borderline dilatation of the ascending aorta in combination with aortic valve replacement: one-year results of a prospective randomized study

Introduction. Borderline dilatation of the ascending aorta (4,2–4,7 cm) is associated with an increased risk of fatal complications but does not always meet the criteria for replacement. Reduction plasty as a less radical alternative requires evaluation of efficacy and safety.

Aim. To evaluate the efficacy and safety of reduction ascending aortoplasty performed simultaneously with aortic valve replacement in patients with borderline aortic dilatation.

Materials and methods. A prospective randomized single-center study was conducted. 40 patients with indications for aortic valve replacement and ascending aorta diameter of 4,2–4,7 cm were randomized into two groups: isolated valve replacement (n=20) and combined intervention with reduction aortoplasty (n=20). Aortic diameter was assessed before surgery, intraoperatively, after surgery, and at 12 months using echocardiography/MSCT.

Results. In the plasty group, a significant reduction in aortic diameter was achieved: from 4,45±0,12 cm to 3,64±0,17 cm after surgery (p<0,001) and 3,67±0,18 cm at 12 months (p<0,001). In the non-plasty group, the diameter remained stable. The annual diameter increase in the plasty group (0,03±0,02 cm) tended to be lower than in the non-plasty group (0,07±0,03 cm), p=0,063. No differences were noted in the duration of cardiopulmonary bypass, myocardial ischemia, operation time, ICU or hospital stay. No cases of aortic dissection, mortality, or reinterventions were recorded during the 12-month follow-up.

Conclusion. Reduction ascending aortoplasty combined with aortic valve replacement is a safe and effective method that provides significant and stable reduction of aortic diameter over 12 months without increasing the risk of early postoperative complications.

1. Zafar M.A., Li Y., Rizzo J.A., Charilaou P., Saeyeldin A., Velasquez C.A., Mansour A.M., Bin Mahmood S.U., Ma W.G., Brownstein A.J., Tranquilli M., Dumfarth J., Theodoropoulos P., Thombre K., Tanweer M., Erben Y., Peterss S., Ziganshin B.A., Elefteriades J.A. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg., 2018, no 155(5), рр. 1938–1950. https://doi.org/10.1016/j.jtcvs.2017.10.140

2. Writing Committee Members, Isselbacher E.M., Preventza O., Hamilton Black I 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. 2.3. Definitions of Dilation and Aneurysm of the Aortic Root and Ascending Thoracic Aorta. J Am Coll Cardiol., 2022, no 80(24), рр. e223–e393. https://doi.org/10.1016/j.jacc.2022.08.004

3. Writing Committee Members, Isselbacher EM, Preventza O, Hamilton Black I 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. 6.5.1. Surgery for Sporadic Aneurysms of the Aortic Root and Ascending Aorta. J Am Coll Cardiol., 2022, no 80(24), рр. e223–e393. https://doi.org/10.1016/j.jacc.2022.08.004

4. Paruchuri V., Salhab K.F., Kuzmik G., Gubernikoff G., Fang H., Rizzo J.A., Ziganshin B.A., Elefteriades J.A. Aortic Size Distribution in the General Population: Explaining the Size Paradox in Aortic Dissection. Cardiology, 2015, no 131(4), рр. 265–272. https://doi.org/10.1159/000433490

5. Bahnson H.T., Nelson A.R. Cystic medial necrosis as a cause of localized aortic aneurysms amenable to surgical treatment. Ann Surg., 1956, no 144(4), рр. 519–529. https://doi.org/10.1097/00000658-195610000-00002

6. Robicsek F., Cook J.W., Reames M.K., Skipper E.R. Size reduction ascending aortoplasty: Is it dead or alive? The Journal of Thoracic and Cardiovascular Surgery, 2004, Volume 128, Issue 4, рр. 562–570, ISSN 0022-5223, https://doi.org/10.1016/j.jtcvs.2004.04.032

7. Wu J., Zeng W., Li X., Zhu J., Zhou C., Fan R., Sun T., Fei H., Li X. Aortic size distribution among normal, hypertension, bicuspid, and Marfan populations. Eur Heart J Imaging Methods Pract., 2023, no 30;1(2), рр. qyad019. https://doi.org/10.1093/ehjimp/qyad019

8. Trumello C., Giambuzzi I., Bargagna M., Tavana K., Bisogno A., Ascione G., Calabrese M., Castiglioni A., Alfieri O., De Bonis M. Long Term Results of Reduction Ascending Aortoplasty. Life (Basel), 2022, no 30;12(10), рр. 1526. https://doi.org/10.3390/life12101526

9. Bernard C., Morgan, M.C., Guillier D., Cheynel N., Bouchot O. Point on the Aortic Bicuspid Valve. Life, 2022, no 12, рр. 518. https://doi.org/10.3390/life12040518