Calculated reduction aortoplasty for dilatation of the ascending aorta associated with aortic valve replacement.

Background: Previous studies have advocated reduction aortoplasty to normalize the diameter of a moderately dilated ascending aorta associated with aortic valve disease. One of the reported techniques is the shawl lapel aortoplasty, which we have adopted and modified by setting a simple set of calculations. We present our midterm results.

Methods: Between February 1996 and February 2004, 25 patients underwent reduction aortoplasty during replacement of their aortic valves. Concomitant cardiac procedures were performed in 11 patients. Eighteen patients had predominantly severe aortic valve stenosis and 7 patients moderate to severe aortic valve insufficiency. Ascending aortic aneurysm size ranged from 43 to 50 mm, measured echocardiographically. In one small sized patient the aorta was 38 mm. Following their discharge patients were instructed to have control echocardiograms every 6 months for the first postoperative year and then annually. They were interviewed by telephone annually to date.

Results: There were no hospital deaths. Twenty-four patients were alive at follow-up, at 2 to 96 months (average 2.9 years). There was one late death, 2 years postoperatively. The first follow-up transthoracic echocardiogram performed at a mean of 6.2 months postoperatively (range, 1-11 months), as well as the subsequent annual echocardiograms in all patients, showed no evidence of further enlargement of the ascending aorta, compared to the reduced diameter obtained during the initial operation. The first 3 patients of this study remained essentially unchanged postoperatively, with only a minor reduction of their aortic diameter.

Conclusions: The shawl lapel technique based on simple calculations, used as a diameter-reduction strategy for ascending aortic dilatation encountered during aortic valve replacement, is an efficacious method with excellent medium-term results.