Letter to the Editor

Dear Editor

Even in the current time of advanced surgical procedures and endovascular alternative techniques for the treatment of aortic pathologies, ascending aortic aneurysms remain a challenging problem for every cardiac surgeon. This is why our utmost interest was focused on the article recently published in your esteemed journal by Ang et al [1]; it dealt with the interesting topic of ascending aortic wrapping in cases of mild to moderate ascending aorta dilatation during aortic valve replacement procedures. Herein, we would like to present our own experience with the wrapping technique, which we used as an alternative procedure in the two-year period 2007 and 2008 in a series of 7 multimorbid patients who were at risk for major surgery, which they definitely refused. During the same period, the number of patients with ascending aortic aneurysm who were submitted to conventional ascending aortic aneurysm operation in our department was 21. The wrapping technique was not necessarily combined with aortic valve repair/replacement, and the morbid conditions of our patients included combinations of advanced age and severe organic or metabolic insufficiencies, such as diabetes mellitus, hypothyreoidism, coronary artery disease, previous CABG, severe heart or renal failure, chronic obstructive pulmonary disease and adipositas per magna. These patients, whose characteristics can be seen in table 1, concentrated classical indications for ascending aorta replacement, but, due to the increased surgical risk and their wish to avoid major surgery, they were submitted to the Dacron wrapping technique, with excellent results in the long-term (18 months ) follow-up control.

Table 1 Patients' baseline characteristics and comorbidities
Full size table

Intra-and perioperative mortality was 0%. In the 18 months' follow-up control none of the patients presented with augmented ascending aortic diameter (as measured per echocardiography and CT angiography). Patient No 2 developed progressive aortic valve insufficiency (with stable aortic diameter), and was submitted to successful biological aortic valve replacement 18 months after the initial operation.

In regard to the issue of neurological and neuropsychiatric complications (stroke, transient ischemic attacks, postoperative delirium), which can consist a 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 surgery due to the significantly increased perioperative risk. We would however wish to emphasize that this technique 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.