V-shape noncoronary sinus remodeling in ascending aortic aneurysm and aortic root ectasia

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Abstract

Objective:

The study objective was to describe our initial experience performing a V-shaped single sinus remodeling procedure in patients with ascending aortic aneurysm and moderate aortic root ectasia.

Methods:

Twelve consecutive patients underwent supracoronary ascending aortic replacement with V-shaped noncoronary sinus remodeling (median age, 63 years [range, 56–77]; 10 patients [83%] were male). All patients had an ascending aortic aneurysm (median diameter 48 mm [range, 42–53]) and aortic root ectasia (median root diameter, 43 mm [range, 38–49.7 mm]). A deep V-shaped (triangular) portion of the noncoronary sinus was excised, and the wall was directly reapproximated in 2 layers, 1 everting mattress suture layer followed by a running over-and-over layer.

Results:

No technical complication due to root remodeling was observed. All patients survived the initial hospitalization. Only 1 patient required reexploration for bleeding, unrelated to the V-shaped repair. On postoperative computed tomography, every patient showed reduction in maximal aortic root diameter and cross-sectional area. Mean aortic root diameter was reduced from 4.30 cm (range, 3.82–4.97) to 3.81 cm (range, 3.58–3.96) (P < .0006). Mean aortic root cross-sectional area was reduced from 1452 mm2 (range, 1327–1615) to 1180 mm2 (range, 961–1328) (P < .0002). Mean wall tension decreased postoperatively by 12%.

Conclusions:

The V-shaped resection of the noncoronary sinus is a viable option for patients with moderate aortic root enlargement. This technique reduces aortic root diameter, cross-sectional area, and wall tension. We offer this technique as another option in the surgeon's armamentarium.

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