[HSF] Ao Wraping

[Ajit Damle]

I operated on a 19 year old last week to replace his aortic valve. (What a
treat! A change from my usual 84 yr old dialysis dependent valves and
CABGs!)

He was known to have a bicuspid valve. In the past few months, he started to
become symptomatic (with LV dilatation) so this was a good time to replace
his valve. He looked Marphanoid, so I had a pre-op CT. That showed, a smooth
fusiform aneurysm starting in the distal ascending aorta, from 1cm below the
brachiocephalic takeoff to proximal arch. The diameter was 3.8cms. For
comparison, the proximal ascending aorta was 2..6 cms and the descending
Aorta was 2.3 cms. The patient is 6' tall and a BSA of 2.3. I was prepared
to replace his arch. I am very confident and comfortable replacing aortic
arches, and touch wood, very lucky. But I had some nagging doubts regarding
the risk/reward ratio in this man.

At surgery, to I found that his aortic tissue strength was quite good. I did
cannulate the undersurface of aortic arch, instead the femoral cannulation I
had planned (I had the fem artery exposed). I replaced the bi-cuspid valve
with a 27 Carbomedics. I used a 28 Hemashield graft to externally wrap the
aorta and sutured it to to the aortic adventitia meticulously, with
substantial dissection,  from just above the coronary ostia to the take-off
of brachio-cephalic laterally and well past it medially, past my aortic
input site.

Before I did the wrapping,  I may point out  that the aortotomy suture line,
the cardioplegia and aortic cannula input site, none required any additional
sutures, indicating that the aortic tissue quality  was good.

Did I do the right thing? I will have this man under CT surveillance for
ever, but still................. 


Ajit Damle
Fargo ND