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.