Volodymyr V.Popov, Leonid L.Sytar ,

Olexandr A. Bolshak, Gennady V..Knyshov

NY 2010

National Amosov Institute of Cardio-Vascular Surgery

Kyiv, Ukraine

WRAPPING TAPE OPERATION (WTO) FOR POSTSTENOTIC ANEURYSM

OF THE ASCENDING AORTA

Aim

To evaluate different methods to correct poststenotic aneurysm of

the ascending aorta (PAAA)

Patient data

Term of the study: 1996 – 2008 yearsn = 442 pts with AS

Age 21 – 71 years, mean 55,1 + 7,5 yearsSex: male - 281 (63,6%)

female - 161 (36,4%)Functional class NYHA: II - 7 (1,6%)

III – 173 (39,1%)IV – 262 (59,3%)

Total – 442 – 100%

Causes of ascending aortic aneurysm

n %

Atherosclerosis, hypertension 296 67,0

Rheumatic fever 140 31,6

Bicuspid aortic valve 3 0,7

Other causes 3 0,7

Total 442 100,0

Operations for PAAA

Methods Quantity of patients

n (%)

AVR+Wrapping Tape Operation 157 35,5

Bentall+Wheat operations 46 10,4

AVR without correction of PAAA 239 54,1

Total 442 100,0

Variations of wrapping operations for PAAA during AVR

Methods Quantity of patients

n (%)

Wrapping tape operation (WTO) 54 34,4

WTO + resection of AAA 18 11,5

WTO + resection of AAA+ plasty of sino-tubular junction (STJ) in area of non-coronary cusp

54 34,4

WTO + plasty of STJ 31 19,7

Total 157 100,0

Methods of surgical treatment of PAAA (n = 442 pts)

All operations were performed with CPB, moderate hypothermia (28-34 C), retrograde crystalloid cardioplegia.

Cell-saver wasn’t use in any case.

Cross-clamping time 79,7 ± 8,2 minutes (group A), 65,5 ± 11,5 minutes (group B) and 121,3 ± 23,1 minutes (group C) (p < 0.05). Blood loss: 285,4±39,4 ml (group A; 19,7% got no donor blood), 425,4±59,4 ml (group B) and 635,1 ± 71,5 ml (group C) (p < 0.05). ICU stay: 55,2 ± 6,1 hours (group A), 58,8 ± 7,2 hours (group B) and

83,4 ± 8,7 hours (group C) (p < 0.05).

Results of operations for PAAA

Methods

Quantity of patients

nHospital mortality

(%)

AVR+Wrapping tape operation 157 0,6

Bentall +Wheat operations 46 6,5

AVR without correction of PAAA 239 1,3

Echo data of PAAA during surgical treatment

Method of treatment

Diameter of ascending aorta (cm)

Before operation

Hospital period

Remote period

AVR+WTO 4,9±0,5 4,0±0,3 4,1±0,2

Benthal’s/ Wheat’s operations

6,5±0,7 3,0±0,3 3,1±0,3

AVR without correction of PAAA

4,8±0,4 4,7±0,3 5,4±0,5

Remote results (n=421 – 96,3 % of discharged patients)

Result WTO Bentall/ Wheat operations

AVR

n % n % n %

Good 87 57.6 21 48.8 49 21.6

Satisfactory 59 39.1 19 44.2 140 61.7

Unsatisfactory 3 2.0 2 4.7 25 11.0

Died 2 1.3 1 2.3 13 5.7

Total 151 100.0 43 100.0 227 100.0

Average term of observation 6,5±0,5 ys

Reoperations (AA’s replacement) – 2,2 % (n=5/227) only in group of AVR without PAA’s correction

Actual analysis of mortality and stability of good and satisfactory results in a remote

period (n=421)

Conclusions

On the basis of clinical experience we recommend the expedient method of WTO for PAAA (diameter of AA ≤ 5,5 cm) during AVR without AA replacement.

Reconstruction of AA with PAAA by WTO is safe and should be performed in cases with AA diameter of 4,5-5,5 cm.