Single aortic sinus repair with double annular sutures in acute type A aortic dissection: a single center case series of seven patients

We evaluated a modified surgical technique designed to preserve and restore the aortic root geometry in patients with acute type A aortic dissection (ATAAD) when the intimal tear is limited to a single coronary sinus. Between January 2015 and December 2021, 160 patients with ATAAD underwent emergency open replacement of the ascending aorta. Most patients (137, 85%) underwent supracoronary ascending aorta replacement. Thirteen patients underwent aorta root replacement with a valved conduit and three underwent valve-sparing aortic root replacement. The remaining seven patients, in whom intimal tears were confined to single coronary sinus, underwent limited root repair using our modified surgical technique: single aortic sinus repair with double annular sutures. Among the seven patients who underwent a single aortic sinus repair, five had coronary sinus dissection, and two had ascending aortic dissection associated with an aneurysmal change of the sinus of Valsalva. The median age at surgery was 59 years (range, 50–74 years). There were no reoperations for postoperative bleeding and no in-hospital mortality. All patients were followed for a median 8 years (range, 3–10 years) postoperatively, and none developed more than mild aortic regurgitation. Our findings suggest that the modified surgical technique-single aortic sinus repair with double annular sutures-may represent a feasible and effective option for selected patients with ATAAD whom the dissection is limited to a single coronary sinus, and the aortic tissue is relatively fragile.