Reduction plasty for borderline dilatation of the ascending aorta in combination with aortic valve replacement: one-year results of a prospective randomized study

Introduction. Borderline dilatation of the ascending aorta (4,2–4,7 cm) is associated with an increased risk of fatal complications but does not always meet the criteria for replacement. Reduction plasty as a less radical alternative requires evaluation of efficacy and safety. Aim. To evaluate the efficacy and safety of reduction ascending aortoplasty performed simultaneously with aortic valve replacement in patients with borderline aortic dilatation. Materials and methods. A prospective randomized single-center study was conducted. 40 patients with indications for aortic valve replacement and ascending aorta diameter of 4,2–4,7 cm were randomized into two groups: isolated valve replacement (n=20) and combined intervention with reduction aortoplasty (n=20). Aortic diameter was assessed before surgery, intraoperatively, after surgery, and at 12 months using echocardiography/MSCT. Results. In the plasty group, a significant reduction in aortic diameter was achieved: from 4,45±0,12 cm to 3,64±0,17 cm after surgery (p<0,001) and 3,67±0,18 cm at 12 months (p<0,001). In the non-plasty group, the diameter remained stable. The annual diameter increase in the plasty group (0,03±0,02 cm) tended to be lower than in the non-plasty group (0,07±0,03 cm), p=0,063. No differences were noted in the duration of cardiopulmonary bypass, myocardial ischemia, operation time, ICU or hospital stay. No cases of aortic dissection, mortality, or reinterventions were recorded during the 12-month follow-up. Conclusion. Reduction ascending aortoplasty combined with aortic valve replacement is a safe and effective method that provides significant and stable reduction of aortic diameter over 12 months without increasing the risk of early postoperative complications.