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Ann Thorac Surg 2004;78:387
© 2004 The Society of Thoracic Surgeons

Correspondence

How to avoid problems with reduction aortoplasty: Reply

Matthias Bauer, MD, Onnen Grauhan, MD, PhD, Roland Hetzer, MD, PhD

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

e-mail: mbauer{at}dhzb.de

To the Editor:

We fully agree with Dr Arsan that reduction aortoplasty with external wrapping can result in severe complications when it is performed technically inadequately. As we [1] suggested in our case report, the main point is the secure anchoring and good fit of the Dacron wrap to avoid alterations in the underlying aortic wall. Robicsek [2], Carrel and co-authors [3], and our group [4] have described successful surgical methods for secure anchoring.

Dr Arsan believes that the problems encountered in reduction aortoplasty with external wrapping are due mostly to the "annuloplasty technique" during wrapping. In the widely accepted aortoplasty techniques, however, an "annuloplasty" is not done. Standard aortoplasty technique consists of the excision of an oval segment of the ascending aorta, which is opened by an extensive longitudinal or S-shaped aortotomy from the aortic clamp into the noncoronary sinus [2–5].

Dr Arsan presents a new method of reduction aortoplasty he calls the "sandwich technique." It is done without incising or excising the diseased aortic wall. The Dacron tube graft is fitted to the aorta longitudinally with the use of separate, full-thickness U sutures.

The classic indications for reduction aortoplasty are poststenotic dilatation [3], dilatation of the ascending aorta in patients with a bicuspid aortic valve [4], and fusiform aneurysm of the ascending aorta [2]. The technique described by Dr Arsan can be applied to fusiform aneurysms without a diseased aortic valve; however, it is not feasible in the case of the first two indications. Also, we believe that his sandwich technique can have pitfalls if it is not carried out technically well.

In conclusion, compared with the reduction aortoplasty technique, the spectrum of indications for the sandwich technique appears limited. However, in principle, Dr. Arsan's method is feasible as an off-pump procedure, which can be an advantage in selected patients.

References

  1. Bauer M., Grauhan O., Hetzer R. Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta. Ann Thorac Surg 2003;75:583-584.[Abstract/Free Full Text]
  2. Robicsek F. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: an alternative to radical resection. Ann Thorac Surg 1982;34:92-94.[Abstract]
  3. Carrel T., von Segesser L., Jenni R., et al. Dealing with dilated ascending aorta during aortic valve replacement: advantages of conservative surgical approach. Eur J Cardio-thorac Surg 1991;5:137-143.[Abstract]
  4. Bauer M., Pasic M., Schaffarzyk R., et al. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve. Ann Thorac Surg 2002;73:720-724.[Abstract/Free Full Text]
  5. Baumgartner F., Omari B., Pak S., Ginzton L., Shapiro S., Milliken J. Reduction aortoplasty for moderately sized ascending aortic aneurysms. J Card Surg 1998;13:129-132.[Medline]




This Article
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Matthias Bauer
Onnen Grauhan
Roland Hetzer
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