Concomitant Wrapping of a Moderately Dilated Ascending Aorta during Aortic Valve Replacement: Postoperative Remodeling of a Distinctive Aorta

Yonsei Medical Journal 2020년 61권 1호 p.40 ~ p.47

김효현(Kim Hyo-Hyun) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Cardiovascular Surgery
이삭(Lee Sak) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Cardiovascular Surgery
이승현(Lee Seung-Hyun) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Cardiovascular Surgery
장병철(Chang Byung-Chul) - CHA University CHA Bundang Medical Center Department of Thoracic and Cardiovascular Surgery
윤영남(Youn Young-Nam) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Cardiovascular Surgery
유경종(Yoo Kyung-Jong) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Cardiovascular Surgery
주현철(Joo Hyun-Chel) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Cardiovascular Surgery

Abstract

Purpose: The long-term outcomes of aortic wrapping in patients with ascending aortic aneurysms, which are rare, but can be fatal, remain poorly understood. This retrospective study analyzed the outcomes of aortic diameter, including aortic root, ascending aorta, and proximal arch diameters, after aortic wrapping during aortic valve replacement surgery.

Materials and Methods: Ninety-six patients with ascending aortic dilation of 40?55 mm who underwent aortic wrapping during aortic valve replacement were selected for this study. Aortic diameter was measured at three levels perioperatively and at follow-up (median time of 9.1±4.2 years). A linear mixed-effects model was used to analyze aortic diameter expansion.

Results: Freedom from adverse aortic events (aortic dissection or rupture, reoperation, or sudden death) at 10 years was 97.9%. No significant dilation at the level of the sinuses of Valsalva (0.069 mm/year, p=0.524) or ascending aorta (0.152 mm/year, p=0.124) was observed. Significant dilation occurred at the proximal aortic arch (0.343 mm/year, p=0.006). Subgroup analysis with a multivariable linear mixed model identified initial ascending aortic diameter to be a significant predictor of proximal arch dilation (p=0.032). Receiver operating characteristic curve analysis revealed that the cut-off for the prediction of proximal arch redilation was an initial mid-ascending aortic diameter of 47.0 mm (area under the curve 0.747, 90% confidence interval 0.613?0.881, p=0.023).

Conclusion: Aortic wrapping could be considered as a safe and long-term therapeutic option. Redilation of the proximal arch should be carefully observed during long-term follow-up.

키워드

Aortic aneurysm, aortic valve, aorta
원문 및 링크아웃 정보
등재저널 정보
SCI(E) MEDLINE 학술진흥재단(KCI) KoreaMed 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
Aortic wrapping results in decreased ascending aortic diameter with long-term stability. No significant dilation at the level of the sinuses of Valsalva (0.069 mm/year, p=0.524) or ascending aorta (0.152 mm/year, p=0.124) was observed.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
KCD코드
ICD 03
건강보험코드