Key result
Aortic valve preservation with root reconstruction for acute type A aortic dissection resulted in 9.3% operative mortality, 100% freedom from root re-operation, and improved severe pre-operative AR.
Why the study?
Does aortic valve preservation with root reconstruction provide durable outcomes in patients with acute type A aortic dissection?
Cohort (n=140)
Does aortic valve preservation with root reconstruction provide durable outcomes in patients with acute type A aortic dissection?
Aortic valve preservation with root reconstruction is a durable surgical approach for acute type A aortic dissection, with 100% freedom from re-operation and sustained improvement in aortic regurgitation at mid-term follow-up.
May support valve preservation in selected acute type A dissection; randomized trials needed to confirm durability versus replacement.
OBJECTIVES: We evaluated the durability of aortic valve preservation with root reconstruction for acute type A aortic dissection (AAAD). METHODS: From January 2002 to March 2011, 140 patients [70 males, 68 ± 12 (SD) years] underwent emergency operation for AAAD. The aortic valve was preserved and one or more Valsalva sinuses were reconstructed. Techniques used for reconstruction were valve resuspension and additional reinforcement of the aortic root with Teflon felt patches, and gelatin-resorcinol-formaldehyde-glue (GRF-glue) was used for mending the dissection. The mean follow-up period was 44.0 ± 26.2 months. We classified the degree of aortic regurgitation (AR) into four grades (0, 1+, 2+ and 3+) using echocardiography. Based on a retrospective analysis of pre-operative echocardiographic findings, the 127 survivors were divided into two groups: group 1 (G1) included 98 patients with 0 or 1+ AR, and group 2 (G2) 29 patients with 2+ or 3+ AR. In addition, we measured the post-operative native aortic root dimension of AAAD patients with use of echocardiography or CT scan. RESULTS: The operative mortality rate was 9.3% (13/140). Freedom from aortic root re-operation was 100%. Aortic root pseudoaneurysm formation and severe AR requiring aortic valve replacement did not occur. Pre-operative AR of 0.2 ± 0.4 in G1 did not deteriorate (0.5 ± 0.5 at discharge, 0.4 ± 0.4 at follow-up). Meanwhile, pre-operative AR of 2.4 ± 0.5 in G2 improved to 0.6 ± 0.5 (P < 0.05) at discharge and 1.0 ± 0.6 (P < 0.05) at follow-up. The native aortic root dimension in G2 at follow-up was significantly larger than G1 (36.0 ± 4.7 vs. 33.9 ± 5.0 mm). CONCLUSIONS: Aortic valve preservation and root reconstruction appear to be an appropriate surgical approach to AAAD.
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Yamanaka et al. (2012) conducted a cohort in Acute type A aortic dissection (n=140). Aortic valve preservation with root reconstruction was evaluated on Operative mortality. Aortic valve preservation with root reconstruction for acute type A aortic dissection resulted in 9.3% operative mortality, 100% freedom from root re-operation, and improved severe pre-operative AR.
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