Investigation of the frequency of arcus and thoracic aortic aneurysms that develop in the late period after surgical treatment of ascending aortic aneurysms

ABSTRACT Investigation of the frequency of aneurysm development in the arcus and thoracic aorta in the late period after surgical treatment in ascending aortic aneurysms. Introduction and Objective: Patients undergoing surgical treatment for Ascending Aortic Dissection or Aneurysm have enlarged sinus Valsalva, arcus aorta and thoracic aorta, dissection flap continuation or rupture. The aim of this study is to determine the incidence of aneurysms in the arcus and descending aorta in the late period in patients who underwent any surgical intervention in the ascending aorta, by providing early diagnosis of these aneurysms, and to provide elective surgical interventions, and to reduce mortality and morbidity in these patients. Material and Method: The late period results, aortic diameters, and other clinical findings of the patients who underwent surgical treatment to the ascending aorta in the last 10 years between 2010 and 2020 were evaluated through postoperative control imaging results and hospital archives. The imaging examinations performed were re-evaluated by the same faculty member from the Radiology Department and data were collected. 197 patients who underwent surgical treatment of the ascending aorta between 2010 and 2020 in the Department of Cardiovascular Surgery at Dokuz Eylul University Hospital, for any reason, were retrospectively analyzed. The number of patients who came to the controls regularly was 61, the study continued with 61 patients, and increases in aortic diameters were observed. Findings and Conclusion: Graft-related complications were seen in 5 patients (8.2%). 2 patients (3.3%) with a distal graft larger than 5 cm. Graft circumference hematoma was observed in 2 patients (3.3%). There was 1 patient (1.6%) with extravasation. There were 11 patients (18%) with an increase in Sinus Valsalva in their follow-up. 4 patients (9.5%) with an increase of less than 0.5 cm. 7 patients (16.7%) with an increase of 0.5-1 cm. There were 6 patients (14.3%) with an increase of more than 1 cm. During the follow-up period of the patients, the mean change in sinus Valsalva increased and was observed as 0.21cm ± 0.16cm. In this evaluation, sinus Valsalva diameter, increasing and decreasing patients were considered. It was observed that there was no significant change in the direction of increase or decrease in the changes in the sinus Valsalva diameter between the preoperative and postoperative period measurements. (p = 0.147) In their follow-up, there were 29 patients (47.5%) with an increase in Arcus Aorta, 15 patients (24.6%) with an increase of less than 0.5 cm, 6 patients with an increase of 0.5-1 cm (9,8%), there were 8 patients (13.1%) with an increase of more than 1 cm. During the follow-up period of the patients, the mean change in the arcus aorta increased and was observed as 0.69cm ± 0.18cm. It was observed that there was a statistically significant change in the direction of increase between the preoperative and postoperative period measurements on the change in the diameter of the arcus aorta of the patients (p = 0.0001). There were 22 patients (36.1%) with an increase in the Thoracic Aorta during their follow-up, 12 patients (19.7%) with an increase of less than 0.5 cm, 6 patients with an increase of 0.5-1 cm (9,8%), there were 4 patients (6.6%) with an increase of more than 1 cm. It was observed that there was a statistically significant change in the direction of increase between the preoperative and postoperative period measurements on the change in the thoracic aorta diameter of the patients (p = 0.0001) In their follow-up, 3 patients with Sinus Valsalva greater than 5 cm (4.9%), 7 patients with Arcus Aorta greater than 5 cm (11.5%), Thoracic Aorta more than 5 cm 4 patients (6.6%) older, 10 patients (16.4%) with continuity dissection flap during follow-up. Patients who underwent surgical treatment for Ascending Aortic Dissection or Aneurysm had an enlargement, dissection flap continuation, or rupture in the sinus Valsalva, arcus aorta, and thoracic aorta in the following years, resulting in the need to follow up these patient groups more frequently.