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Báo cáo y học: "An alternate solution for the treatment of ascending aortic aneurysms: the wrapping technique"

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Tagarakis et al. Journal of Cardiothoracic Surgery 2010, 5:100 http://www.cardiothoracicsurgery.org/content/5/1/100 LETTERS TO THE EDITOR Open Access An alternate solution for the treatment of ascending aortic aneurysms: the wrapping technique Georgios I Tagarakis1*, Dimos Karangelis1, Andony J Baddour1, Marios E Daskalopoulos1, Vassilios T Liouras1, Dimitrios Papadopoulos2, Konstantinos Stamoulis2, Stefania S Lampoura1, Nikolaos B Tsilimingas1 Abstract Background: The aortic Dacron wrapping technique is a surgical technique used under certain circumstances in cases of ascending aorta dilatation. Herein, we are presenting our experience on the method performed on multimorbid patients who denied major aortic surgery. Methods: We included in our series 7 patients (5 male-2 female) with mild to moderate ascending aortic dilatation, who were operated with the wrapping technique. One patient was submitted to biological aortic valve replacement during the same procedure. The number of conventionally operated patients during the same period (2 years) was 21. Results: Mortality during the 18-months follow-up control was 0%. One patient had to be operated with biological aortic valve replacement 18 months after the initial wrapping operation, although the diameter of her ascending aorta remained stable. Conclusions: The Dacron wrapping technique is a method that can alternatively be used in multimorbid patients with mild to moderate ascending aortic dilatation without dissecting elements and has generally good results. Letter to the Editor refused. During the same period, the number of patients with ascending aortic aneurysm who were submitted to Dear Editor Even in the current time of advanced surgical proce- conventional ascending aortic aneurysm operation in dures and endovascular alternative techniques for the our department was 21. The wrapping technique was treatment of aortic pathologies, ascending aortic aneur- not necessarily combined with aortic valve repair/repla- ysms remain a challenging problem for every cardiac cement, and the morbid conditions of our patients surgeon. This is why our utmost interest was focused included combinations of advanced age and severe on the article recently published in your esteemed jour- organic or metabolic insufficiencies, such as diabetes nal by Ang et al [1]; it dealt with the interesting topic of mellitus, hypothyreoidism, coronary artery disease, pre- ascending aortic wrapping in cases of mild to moderate vious CABG, severe heart or renal failure, chronic ascending aorta dilatation during aortic valve replace- obstructive pulmonary disease and adipositas per ment procedures. Herein, we would like to present our magna. These patients, whose characteristics can be own experience with the wrapping technique, which we seen in table 1, concentrated classical indications for used as an alternative procedure in the two-year period ascending aorta replacement, but, due to the increased 2007 and 2008 in a series of 7 multimorbid patients surgical risk and their wish to avoid major surgery, they who were at risk for major surgery, which they definitely were submitted to the Dacron wrapping technique, with excellent results in the long-term (18 months ) follow- up control. * Correspondence: gtagarakis@gmail.com Intra-and perioperative mortality was 0%. In the 18 1 Department of Cardiovascular and Thoracic Surgery, University of Thessaly, months ’ follow-up control none of the patients Larissa, Greece Full list of author information is available at the end of the article © 2010 Tagarakis et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Tagarakis et al. Journal of Cardiothoracic Surgery 2010, 5:100 Page 2 of 2 http://www.cardiothoracicsurgery.org/content/5/1/100 Table 1 Patients’ baseline characteristics and comorbidities Patient Gender Age Aortic valve insufficiency/indication Ascending Comorbidities number for surgical repair or replacement aortic diameter Patient Male 74 Mild to moderate, aortic valve 5.3 cm Diabetes mellitus, arterial hypertension, renal failure, 1 replacement performed Patient Female 70 Mild 5.4 cm Diabetes mellitus, arterial hypertension, adipositas per magna, 2 heart failure (left ventricular ejection fraction 45%) Patient Male 78 Mild 5.3 cm Diabetes mellitus, arterial hypertension, renal failure (dialysis), 3 previous CABG Patient Male 74 Mild 5.5 cm Diabetes mellitus, arterial hypertension, coronary artery disease, 4 previous CABG Patient Male 80 Mild 5.4 cm Diabetes mellitus, arterial hypertension, hyperlipidemia, coronary 5 artery disease, heart failure, left ventricular ejection fraction 30%) Patient Female 73 Mild 5.4 cm Arterial hypertension , chronic obstructive pulmonary disease, 6 adipositas per magna Patient Male 77 Mild 5.4 cm Arterial hypertension, previous CABG, chronic obstructive 7 pulmonary disease presented with augmented ascending aortic diameter (as Received: 3 September 2010 Accepted: 3 November 2010 Published: 3 November 2010 measured per echocardiography and CT angiography). Patient No 2 developed progressive aortic valve insuffi- Reference ciency (with stable aortic diameter), and was submitted 1. Ang KL, Raheel F, Bajaj A, Sosnowski A, Galinanes M: Early impact of aortic to successful biological aortic valve replacement 18 wrapping on patients undergoing aortic valve replacement with mild to moderate ascending aorta dilatation. J Cardiothorac Surg 2010, 5:58. months after the initial operation. In regard to the issue of neurological and neuropsy- doi:10.1186/1749-8090-5-100 Cite this article as: Tagarakis et al.: An alternate solution for the chiatric complications (stroke, transient ischemic treatment of ascending aortic aneurysms: the wrapping technique. attacks, postoperative delirium), which can consist a Journal of Cardiothoracic Surgery 2010 5:100. major problem after aortic surgery, we are glad to report that no incidents of the kind were observed. In conclusion, the Dacron wrapping technique can be an alternative solution for ascending aortic aneurysms without dissecting elements in cases of severely morbid patients who are unwilling to undergo major aortic sur- gery due to the significantly increased perioperative risk. We would however wish to emphasize that this techni- que should not be misused as a standard procedure in cases of ascending aortic dilatation, but adopted only in exceptional cases where mild to moderate dilatation, advanced age and major comorbidities are combined with the patient’s wish to avoid major aortic surgery. Conflicts of interest The authors declare that there are no conflicts of interest. Submit your next manuscript to BioMed Central and take full advantage of: Author details 1 Department of Cardiovascular and Thoracic Surgery, University of Thessaly, Larissa, Greece. 2Department of Anesthesiology, University of Thessaly, • Convenient online submission Larissa, Greece. • Thorough peer review Authors’ contributions • No space constraints or color ﬁgure charges G T is the main author of the manuscript and member of the surgical team. • Immediate publication on acceptance DK coauthored the paper. AB was a member of the surgical team. MD • Inclusion in PubMed, CAS, Scopus and Google Scholar performed linguistic control. VL was a member of the surgical team. DP was member of the anesthesiological team. KS was member of the • Research which is freely available for redistribution anesthesiological team. SL performed linguistic control. N T was the primary surgeon and performed the final control. Submit your manuscript at www.biomedcentral.com/submit

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