Key result
Supracoronary aortic replacement during acute Type A aortic dissection surgery resulted in a similar rate of long-term aortic root reoperation compared to aortic root replacement (3.3% vs 5.1%, p=0.636).
Why the study?
Management of the aortic root during acute Type A aortic dissection repair remains controversial regarding long-term evolution and reoperation.
Does supracoronary aortic replacement compared to aortic root replacement reduce reoperation on the aortic root in patients with acute Type A aortic dissection?
Cohort (n=164)
No
Does supracoronary aortic replacement compared to aortic root replacement reduce reoperation on the aortic root in patients with acute Type A aortic dissection?
Absolute Event Rate: 3.3% vs 5.1%
p-value: p=0.636
Supracoronary aortic replacement is an effective technique for primary Type A aortic dissection surgery that does not increase the rate of late reoperation on the aortic root compared to aortic root replacement.
Supports supracoronary replacement yielding comparable reoperation rates; leaves open randomized evaluation of root strategy in acute Type A dissection.
Background Management of the aortic root during acute Type A aortic dissection (TAAD) repair remains controversial in term of long-term evolution and reoperation. The aim of this study was to assess the long-term outcomes of the aortic root after conservative management during primary surgery. Methods One hundred sixty-four consecutive patients were included in this monocentric retrospective study. The primary endpoint was reoperation on the aortic root during long-term follow-up. Forty-six patients had aortic root replacement (ARR) and 118 had supracoronary aortic replacement (SCR). The 10-year survival, occurrence of significant aortic regurgitation, and radiologic aortic root dilatation in each group were assessed during follow-up. Results Patients from ARR group were younger than those from SCR group (p < 0.0001). Median follow-ups of ARR group and SCR group are 4.4 (interquartile range [IR]: 2.6–8.3) and 6.15 (IR: 2.8–10.53) years, respectively. Reoperation of the aortic root during long-term follow-up was similar in both groups (ARR group: 5.1%, SCR group: 3.3%, p = 0.636). The 10-year survivals of ARR and SCR groups were 64.8 ± 12.3% and 46.3 ± 5.8% (p = 0.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups (p = 0.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies (p = 0.58). Reoperation on the distal aorta (p = 0.012) and patent radiologic false lumen of the descending aorta (p = 0.043) were independent risk factors of late death. Conclusion SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root.
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Baufreton et al. (2021) conducted a cohort in Acute Type A aortic dissection (TAAD) (n=164). Supracoronary aortic replacement (SCR) vs. Aortic root replacement (ARR) was evaluated on Reoperation on the aortic root during long-term follow-up (p=0.636). Supracoronary aortic replacement during acute Type A aortic dissection surgery resulted in a similar rate of long-term aortic root reoperation compared to aortic root replacement (3.3% vs 5.1%, p=0.636).
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