Reduction ascending aortoplasty: midterm follow-up and predictors of redilatation

Background: Reduction ascending aortoplasty is an alternative procedure to the replacement of the ascending aorta in case of ascending aorta aneurysm without aortic root involvement. This study was designed to evaluate the midterm follow-up of aortoplasty and to determine predictors of redilatation. Methods: From January 1, 1998, to April 30, 2005, 68 patients with dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with other cardiac procedures. All patients underwent associated surgical procedures. Sixty patients (88.2%) underwent associated aortic valve replacement. Cumulative follow-up time was 191.4 patient-years and was 100% complete. Median follow-up time was 2.5 years, and mean follow-up time was 2.9 (plus or minus) 1.7 years (range, 0.4 to 6.3 years). Results: The overall perioperative mortality rate was 1.5%. Overall survival estimates at 3 and 6 years were 93.3% (plus or minus) 4.5% and 89.3% (plus or minus) 5.9%, respectively. The actuarial freedom from cardiac-related death at 3 and 6 years was 100% and 95.7% (plus or minus) 4.3%, respectively. Ascending aorta redilatation occurred in 5 patients (7.5%). The actuarial freedom from redilatation at 3 and 6 years was 97.7% (plus or minus) 2.3% and 79.8% (plus or minus) 8.4%, respectively. The actuarial freedom from reoperation at 3 and 6 years was 100% and 86.3% (plus or minus) 7.5%, respectively. Only preoperative diameter was a significant predictor of redilatation using multivariate stepwise logistic regression analysis. Conclusions: Unsupported reduction aortoplasty is a safe and effective technique with low mortality, low morbidity, and rare late complications for selected chronic aneurysm of the ascending aorta with diameter less than 55 mm.