INTRODUCTION
In the early period of cardiac surgery pump time and ischemic time were strictly correlated to perioperative mortality. The consequence was that all the efforts were targeted to reduce the duration of these procedural parts. The ascending aorta (AA) aneurysms were treated by wall plication, or aortoplasty, or wrapping or a mixture of them1-6. This experience was maintained over time, even if the analysis of the long-term results sometimes led to some concerns. Among these techniques, external wrapping was used first to support the ascending aorta after reduction aortoplasty, but later it became more popular as the only tool to reduce the AA size, as it does not need extracorporeal circulation. The concept of wrapping as a support without aortoplasty has been recently revisited by Golesworthy et al7, who introduced the personalized external aortic root support, developed as an alternative method to prevent dilatation of the aortic root in patients with Marfan’s syndrome. However, this device is based on computer-aided design and 3D printing of the individual’s AA on which the supporting mesh (microporous polyethylene terephthalate) is manufactured. It is a pre-emptive operations, addressed in general to patients with aortopathies with a AA size from 40 mm to not more than 60 mm8.
The material used for conventional wrapping of the ascending aorta (WAA) is a microporous polyethylene terephthalate (dacron) tubular graft, which is rigid and changes the ascending aorta in a tubular pipe. We decided to use the fresh autologous pericardium (FAP) not to reduce the AA diameter, but to stabilize its dimension to more or less the same at the baseline. The rationale was that FAP had some elasticity, that allowed the AA to adapt to changes in hemodynamic stresses, does not calcify or retract, as it is not inside the bloodstream, and it is able to adapt to the AA shape. We herein report the early and late results of our experience.