Early impact of aortic wrapping on patients undergoing aortic valve replacement with mild to moderate ascending aorta dilatation

BACKGROUND The management of mild to moderate dilatation of the ascending aorta of less than 5 cm is controversial, particularly when concomitant surgical correction of aortic valve is required. We investigate the impact of a simple method of aorta reduction using Dacron graft wrapping during aortic valve replacement on the rest of the aorta. METHODS We studied 14 patients who had ascending aorta dilatation of 4-5 cm before undergoing aortic wrapping during their aortic valve replacement and compared with their post-operative imaging within a month. RESULTS The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within 4 weeks after surgery from 44.7 +/- 2.6 to 33.6 +/- 3.9 mm (p < 0.001). This was associated with significant reduction in the diameter of rest of ascending aorta: coronary sinuses (from 37.9 +/- 4.9 mm to 33.3 +/- 6.1 mm; p < 0.001), sinotubular junction (from 33.2 +/- 4.7 mm to 30.6 +/- 4.4 mm, p = 0.02), and aortic arch (from 34.7 +/- 4.3 mm to 32.6 +/- 4.1 mm, p = 0.03). CONCLUSIONS Reduction of ascending aortic dilatation by wrapping with a Dacron graft in this preliminary study is associated with favourable early reversed aortic remodelling. This supports the hypothesis that correction of mild-moderate dilatation of the ascending aorta with Dacron wrapping at the time of aortic valve surgery may prevent the progression of the dilatation, although the long-term study on a larger population is needed to confirm its benefits.