Our Experience with Aortic Plication Compared to Tube Graft Replacement for Dilated Ascending Aorta

Background: Replacement of the ascending aorta with a Dacron tube is the gold standard treatment for pathologically dilated aorta. We encounter aneurysms of the ascending aorta mostly in patients with bicuspid valves but also in other occasions. We decided to evaluate the clinical outcomes of a repair of moderately dilated ascending aorta by means of aortic plication compared with replacement for the ascending aorta with a Dacron tube.

Methods: Between the years of 2004-2018, 658 patients underwent surgery of ascending aorta due to aneurysms, of them, in 281 patients the ascending aorta was 55mm or less. 235 patients underwent replacement of the ascending aorta and 51 patients underwent plication of the ascending aorta. After propensity score matching we achieved a group of 45 patients who underwent replacement versus a group of 45 patients who underwent plication. The mean age was 58±14 years and 52±17 years in the plication and tube replacement groups respectively (p=0.006). The mean maximal pre-operative aorta diameter was of 4.5±0.5 mm and 4.3±0.7 mm in the plication and tube replacement groups respectively (p=0.292).

All patients were prospectively followed and clinical and echocardiographic outcomes were compared and analyzed.

Results: There was one hospital mortality in the plication group and none in the replacement (p=1.00). Early bleeding that led to revision was 7% in the replacement group versus 9% in the plication group (p= 1.000). At a mean follow-up of 60±48 months (range 1-175), survival was 86% in the replacement group versus 95% in the plication group (p=0.108).

Late reoperation on the ascending aorta was 0% in the replacement group versus 2% (1 pts) in the plication group (p=1.00). Late Echocardiography (50±44 months) showed a mean aortic diameter of 4.1±0.5 mm and 3.3±0.5mm in the plication and tube replacement groups respectively (p=0.000).

Conclusions: At mid-term follow-up plication of the ascending aorta resulted in similar clinical outcomes but with larger aortic diameters, Longer term follow-up is needed in order to evaluate the safety of this approach.