As all Cardiac Surgeons, we are faced with patients who have a dilated ascending aorta with associated AS. Most of these patients have a bicuspid AV. We have learned that patients who have a 4.5cm or greater ascending aorta should have the ascending aorta replaced concomitantly. But what do we do with those who have a 4cm aorta? I believe that if we are faced with this scenario, and the sinotubular junction is not dilated, we should replace the AV and perform a longitudinal ascending aortoplasty along the greater curvature of the aorta. One to 2cm of aorta is resected longitudinally in the direction of the greater curvature extending to the non coronary annulus, then when closing the aortotomy, an additional 1cm of aorta is plicated. I believe that we are replacing to many aortas and this may prove to be a very viable alternative. I have provided a few pictures to demonstrate a minimally invasive approach which have have now performed on 5 cases with this pathology.
Posted in Aortic Valve Surgery