Key result
A preoperative aortic root diameter ≥50 mm was independently associated with a significantly increased risk of long-term proximal aortic reoperation compared with a diameter <45 mm (aHR 15.7).
Why the study?
The study sought to evaluate long-term outcomes following root preservation and identify the root diameter warranting concomitant replacement during acute type A aortic dissection repair.
Does a preoperative aortic root diameter ≥50 mm increase the risk of proximal aortic reoperation in patients undergoing acute type A aortic dissection repair with root preservation?
Cohort (n=594)
No
Does a preoperative aortic root diameter ≥50 mm increase the risk of proximal aortic reoperation in patients undergoing acute type A aortic dissection repair with root preservation?
In patients undergoing acute type A aortic dissection repair, preserving an aortic root with a diameter ≥50 mm is associated with a significantly higher risk of long-term proximal aortic reoperation, whereas roots <50 mm can be safely preserved.
Answers are grounded in this paper and cite their sources.
A root diameter ≥50 mm was associated with higher reoperation risk after ATAAD repair; leaves open whether replacement improves outcomes.
Objectives: To evaluate long-term outcomes after root preservation and identify the root diameter warranting concomitant replacement during acute type A aortic dissection (ATAAD) repair. Methods: Between January 2010 and December 2023, 681 patients with ATAAD underwent surgical repair. After excluding bicuspid aortic valve and connective tissue disorders, 42 patients underwent aortic root replacement or repair and 594 patients underwent ascending or total arch replacement with preservation of the native root. The patients were divided into 3 groups according to the aortic root diameter: <45 mm (group A; 535 patients), ≥45 and <50 mm (group B; 41 patients), and ≥50 mm (group C; 18 patients). Conclusions: During surgery for ATAAD, an aortic root with a diameter ≥50 mm should be replaced, given significantly higher 5- and 10-year proximal aortic reoperation rates. In patients with aortic root diameters <50 mm, even if ≥45 mm, the aortic root may be preserved.
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Yoshitake et al. (2026) conducted a cohort in Acute type A aortic dissection (n=594). Preoperative aortic root diameter ≥50 mm vs. Preoperative aortic root diameter <45 mm was evaluated on Freedom from proximal aortic reoperation at 10 years (aHR 15.7, 95% CI 4.9-50.6, p=<.0001). A preoperative aortic root diameter ≥50 mm was independently associated with a significantly increased risk of long-term proximal aortic reoperation compared with a diameter <45 mm (aHR 15.7).
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