Key result
Aortic root replacement in acute type A aortic dissection showed conflicting impacts on mortality but strong evidence of reduced reoperation risk compared to root preservation.
Why the study?
There is controversy regarding root management in acute type A aortic dissection, comparing aggressive root replacement versus conservative approaches to preserve native structures.
Does aortic root replacement improve mortality and reduce reoperation rates compared to root preservation in patients with acute type A aortic dissection?
Systematic Review
Does aortic root replacement improve mortality and reduce reoperation rates compared to root preservation in patients with acute type A aortic dissection?
In acute type A aortic dissection, aortic root replacement reduces the risk of future root reoperation compared to preservation, though mortality benefits remain unclear and highly dependent on patient-specific factors.
May reduce reoperations without clear mortality benefit in acute type A dissection; leaves open optimal strategy pending randomized data.
BACKGROUND: Acute type A aortic dissection (ATAAD), is a surgical emergency often requiring intervention on the aortic root. There is much controversy regarding root management; aggressively pursuing a root replacement, versus more conservative approaches to preserve native structures. METHODS: Electronic database search we performed through PubMed, Embase, SCOPUS, google scholar, and Cochrane identifying studies that reported on outcomes of surgical repair of ATAAD through either root preservation or replacement. The identified articles focused on short- and long-term mortalities, and rates of reoperation on the aortic root. RESULTS: There remains controversy on replacing or preserving aortic root in ATAAD. Current evidence supports practice of both trends following an extensive decision-making framework, with conflicting series suggesting favorable results with both procedures as the approach that best defines higher survival rates and lower perioperative complications. Yet, the decision to perform either approach remains surgeon decision and bound to the extent of the dissection and tear entries in strong correlation with status of the aortic valve and involvement of coronaries in the dissection. CONCLUSIONS: There exists much controversy regarding fate of the aortic root in ATAAD. There are conflicting studies for impact of root replacement on mortality, whilst some study's report no significant results at all. There is strong evidence regarding risk of reoperation being greater when root is not replaced. Majority of these studies are limited by the single centered, retrospective nature of these small sample sized cohorts, further hindered by potential of treatment bias.
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Munir et al. (2020) conducted a systematic review in Acute type A aortic dissection (ATAAD). Aortic root replacement vs. Aortic root preservation was evaluated on Short- and long-term mortalities, and rates of reoperation on the aortic root. Aortic root replacement in acute type A aortic dissection showed conflicting impacts on mortality but strong evidence of reduced reoperation risk compared to root preservation.
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