Volodymyr V.Popov, Leonid L.Sytar, Olexandr A. Bolshak, Gennady V..Knyshov NY 2010 National Amosov Institute of Cardio-Vascular Surgery Kyiv, Ukraine WRAPPING.

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Presentation transcript:

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 years n = 442 pts with AS Age 21 – 71 years, mean 55,1 + 7,5 years Sex: male (63,6%) female (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, hypertension29667,0 Rheumatic fever14031,6 Bicuspid aortic valve30,7 Other causes30,7 Total442100,0

Operations for PAAA Methods Quantity of patients n(%) AVR+Wrapping Tape Operation15735,5 Bentall+Wheat operations4610,4 AVR without correction of PAAA23954,1 Total442100,0

Variations of wrapping operations for PAAA during AVR Methods Quantity of patients n(%) Wrapping tape operation (WTO)5434,4 WTO + resection of AAA1811,5 WTO + resection of AAA+ plasty of sino-tubular junction (STJ) in area of non-coronary cusp 5434,4 WTO + plasty of STJ3119,7 Total157100,0

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 n Hospital mortality (%) AVR+Wrapping tape operation1570,6 Bentall +Wheat operations466,5 AVR without correction of PAAA2391,3

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±0,54,0±0,34,1±0,2 Benthal’s/ Wheat’s operations 6,5±0,73,0±0,33,1±0,3 AVR without correction of PAAA 4,8±0,44,7±0,35,4±0,5

Remote results (n=421 – 96,3 % of discharged patients) ResultWTOBentall/ Wheat operations AVR n%n%n% Good Satisfactory Unsatisfactory Died Total 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.