Long-Term Experience of Girdling the Ascending Aorta With Dacron Mesh as Definitive Treatment for Aneurysmal Dilation Oved Cohen, MD, Jonah Odim, MD,

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Long-Term Experience of Girdling the Ascending Aorta With Dacron Mesh as Definitive Treatment for Aneurysmal Dilation Oved Cohen, MD, Jonah Odim, MD, PhD, David De La Zerda, MD, Chidi Ukatu, MD, Raj Vyas, BS, Neil Vyas, BA, Kathy Palatnik, BS, Hillel Laks, MD The Annals of Thoracic Surgery Volume 83, Issue 2, Pages S780-S784 (February 2007) DOI: 10.1016/j.athoracsur.2006.10.086 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Operative view shows the mechanism of girdling the dilated ascending aorta with fine Dacron mesh and gradual narrowing of diameter with multiple right-angle clamps secured with multiple interrupted 3-0 polypropylene mattress sutures. The Annals of Thoracic Surgery 2007 83, S780-S784DOI: (10.1016/j.athoracsur.2006.10.086) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Dacron mesh technique of wrapping the dilated ascending aorta with suture fixation in the noncoronary sinus at the ventricular aortic junction, with care taken not to compromise the right and left coronary arteries, and distal anchoring at the pericardial reflection at the take-off of the innominate artery. The Annals of Thoracic Surgery 2007 83, S780-S784DOI: (10.1016/j.athoracsur.2006.10.086) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Final operative view demonstrates aortic diameter reduction of a dilated aneurysmal ascending aorta with fine Dacron mesh wrap. The Annals of Thoracic Surgery 2007 83, S780-S784DOI: (10.1016/j.athoracsur.2006.10.086) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Histopathologic cross-section trichrome staining of aorta wrapped with fine Lars Dacron mesh (arrows) in white light and polarized light demonstrates the absence of hematoma formation between the wrap and aortic adventitia and no erosion of mesh through the wall. There is severe fibrosis in the outer half of the aortic wall (A), with diffuse loss of elastic tissue in the media. The medial degenerative changes of the media are associated with adventitial fibrosis with foreign body giant cell reaction associated with the presence of the Dacron wrap. This 33-year-old man with Marfan syndrome underwent aortic valve repair with subcommissural annuloplasties, repair of sinuses with glutaraldehyde-treated pericardial patches, and Dacron mesh wrap of the ascending aorta. Two years later, he required aortic valve repair for severe insufficiency. The Annals of Thoracic Surgery 2007 83, S780-S784DOI: (10.1016/j.athoracsur.2006.10.086) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions