Off-Pump Plicating Ascending Aortoplasty With External Wrapping: Magnum in Parvo

Background: Isolated, fusiform aneurysms, exclusively affecting the tubular portion of the ascending aorta, are rare. Surgical treatment aims to change their natural course, reducing individual and cumulative risks of rupture, dissection and death. Open tubular graft replacement still remains the procedure of choice, despite significant risks. In permanent pursuit for optimal, alternative surgical strategy in high-risk patients, less invasive and off-pump plicating ascending aortoplasty with modified external Dacron graft wrapping seems to be a reliable choice.

Methods: Two (2) consecutive patients were operated on. The same preoperative calculations and slightly different operative techniques were applied regarding surgical exposure and wrapping graft orientation. Immediate and late follow-up (5 years) results were compared.

Results: Absolute and indexed target ascending aortic diameters remained acceptable (<2.1cm/m² considered the upper normal range for adults). There were no significant changes in proximal and distal aortic diameters. Ascending aortic silhouette on contrast enhanced multi-detector CT was better with Dacron wrapping graft tailored to have its grooves in the longitudinal direction. Upper mini-sternotomy was quite appropriate for this procedure, from a surgical point of view, and was safe for the patient.

Conclusions: Careful patient selection and using the current model of preoperative calculations and surgical technique resulted in acceptable and stable ascending aortoplasty in high-risk patients 5 years after surgery.