Modified Aortic Valve Reimplantation in Patients With Acute Aortic Dissection Type A

Background The question of choosing surgical tactics in patients with acute aortic dissection type A unresolved to now. In patients with massive destruction of the aortic root the «gold standard» is the Bentall procedure. Aortic valve reimplantation is an attractive alternative, especially in patients with preserved aortic valve leaflets anatomy. Objective To compare the results of the use of valve sparing procedure and composite root replacement in patients with acute aortic dissection type A. Methods At the end, 62 patients were included in the study. Of those, 27 patients undervent aortic valve reimplantation and 35 had Bentall’s operation in the Kouchoukos modification. Results Preoperative demographic and clinical characteristics were such between the groups. Similar indicators of preoperative malperfusion were observed in both groups. The time of artificial circulation (p=0.125) and aortic clamping time (p=0.001) were longer in the reimplantation group, while the time of circulatory arrest was longer in the Bentall group (p=0.290). The average aortic clamping time was about 30 minutes longer in the first group. Hospital mortality in the reimplantation group was 8.3% and 22.9% in the Bentall group. Mortality from all causes in the long-term period was 6 people in the reimplantation group 25%, 10 people in the Bentall group 28.6%. The degree of aortic regurgitation did not increase in any case until the moment of extreme contact with the patient. Conclusions Aortic valve reimplantation can be performed with good immediate and long-term results in patients with preserved aortic valve leaflets with acute aortic dissection type A.