DRAWBACK OF AORTOPLASTY FOR ANEURYSM OF THE ASCENDING AORTA ASSOCIATED WITH AORTIC-VALVE DISEASE

Background. Aortoplasty has been advocated for moderate dilatation of the ascending aorta associated with aortic valve disease. We report ou r results with this conservative approach. Methods. Seventeen consecut ive patients with unsupported aortoplasty were reviewed. Twelve patien ts had aortic valve regurgitation and 5 had stenosis. The aortic wall was analyzed histologically in 14 patients. Follow-up was complete, wi th a mean time of 6 years (range, 2.3 to 10.5 years). Results. Two pat ients among the 15 hospital survivors died during follow-up of causes unrelated to aortic pathology. survival at 7 years was 86.7% (+/-8.8%) . Recurring aortic aneurysms developed in 4 patients after a mean time of 63 months, with an event-free survival at 7 years of 41% (+/-21%). All of these 4 patients had aortic valve regurgitation and cystic med ial necrosis. Conclusions. The recurrence rate of aneurysms after unsu pported aortoplasty and aortic valve replacement is high in patients w ith aortic regurgitation. This strongly suggests that in these patient s, the aortic dilatation is related to an underlying wall deficiency, associated with the aortic valve pathology, rather than to the hemodyn amic stress imposed by the aortic valve disease. (C) 1997 by The Socie ty of Thoracic Surgeons.