Aortic valve sparing operations versus composite graft implantation in acute aortic dissections

Objectives: Type A acute aortic dissection is life-threatening disease requiring urgent operation.The type of the operation is often a subject of discussion.In our study we present our first experience with two different types of operation with and without preservation of the aortic valve.Patients and methods: From January 2009 to December 2011 fifty-six patients underwent the operation due to the acute aortic dissection type A. Ascending aorta was replaced in 32 cases and more complex operation was performed in 24 patients due to the simultaneous severe aortic root damage by dissection (study group).In eleven patients (group A) replacement of aortic valve, aortic root and ascending aorta by composite graft (modified Bentall procedure) was performed and in 13 patients (group B) valve sparing operation (reimplantation according to David) was carried out.Results: There were no significant differences between the groups in preoperative variables.The only significant difference was mean duration of hospitalization; 26.7 ± 13.7 days in group A and 16.4 ± 7.7 days in group B. Hospital mortality was 18.2 % (n = 2) after Bentall procedure, no patient died in group B. There were no or minimal aortic regurgitation in all patients of group B on echocardiography before discharge.The mean follow-up was 17.6 months (3.6-35.8) in group A, and 23.5 months (7.9-38.9) in group B. During this period of time three patients in group A and one patient in group B died; two of cardiac and two of noncardiac reasons.In group B no patient had aortic regurgitation higher than grade I and all patients were in New York Heart Association functional class I or II.Conclusion: Aortic valve reimplantation in patients with type A dissection can be performed with excellent early and mid-term results.In the hands of an experienced surgeon it represents a good alternative to the Bentall operation.Its main advantage is the preservation of the native valve without the necessity of anticoagulation therapy. SOUHRNCíl: Akutní disekce aorty typu A je život ohrožujícím onemocněním, které vyžaduje urgentní operační řešení.Volba ideálního postupu je stále předmětem diskusí.V práci prezentujeme naše zkušenosti se dvěma typy operací se zachováním a bez zachování aortální chlopně.Soubor a metodika: V období od ledna 2009 do prosince 2011 bylo na našem pracovišti operováno 56 pacientů pro akutní disekci aorty typu A. Ve 32 případech byla nahrazena ascendentní aorta a u 24 pacientů byl z důvodu závažnějšího postižení aortálního kořene proveden rozsáhlejší výkon (studijní skupina).U jedenácti z těchto pacientů (skupina A) byla nahrazena aortální chlopeň, kořen a ascendentní aorta konduitem s chlopní (modifikovaná Bentallova operace).Ve 13 případech (skupina B) byla provedena záchovná operace aortální chlopně (reimplantace dle Davida).