Surgical management of ascending aortic aneurysm due to non-infectious aortitis.

OBJECTIVES: We reviewed the spectrum of disease and early outcomes of patients undergoing ascending aortic surgery for Giant cell aortitis (GCA).

DESIGN: Of 1 259 patients undergoing repair of ascending aortic aneurysms between January 1993 and July 2006, 100 had histologic evidence of GCA or lymphoplasmacytic aortitis.

RESULTS: Operative Mortality was 4% (4/100). One patient underwent aortoplasty and aortic valve replacement (AVR). Among 99 patients undergoing graft replacement of the ascending aorta, distal disease required hemiarch replacement in 33 and total arch replacement in 14. Proximal aneurismal disease of the root was managed by mechanical or biological root replacement (n=18), Yacoub remodeling (n=2) or David reimplantation (n=9). Another 12 patients had separate AVR and ascending graft, while 26 had AR corrected by restoration of proper sinotubular junction diameter. In total, of 63 patients with AR, 38 had a valve-preserving procedure (61%).

CONCLUSIONS: Ascending aortic aneurismal disease due to GCA is frequently associated with proximal and/or distal disease. Valve sparing procedures are technically feasible for many, although late durability is uncertain.