Mid-term Outcomes of Valve-sparing Aortic Root Replacement Versus the Bentall Procedure for Middle-aged Chinese Patients with Acute DeBakey I Aortic Dissection: A Single-center Retrospective Study.

Background: The mid-term and long-term efficacies of valve preservation in acute DeBakey I aortic dissection(AD) are controversial. Thus, it is unclear whether middle-aged patients with acute DeBakey I AD should undergo valve-sparing procedures or the Bentall procedure in an emergency setting.Methods: This study included 213 middle-aged Chinese patients(30-60 years old) who were treated for acute DeBakey I AD between January 2009 and June 2015. The treatments involved valve-sparing aortic root replacement(VSARR)(117 patients) or the Bentall procedure(96 patients). Preoperative, intraoperative, postoperative, and follow-up data were analyzed. Echocardiography and thoracoabdominal computed tomography angiography(CTA) findings were reviewed at 3 months, 1 year, and then annually after surgery. Results: No significant differences were observed in terms of the preoperative, intraoperative, in-hospital mortality, and postoperative parameters. There were also no significant differences in aortic regurgitation(AR). However, follow-up examinations using CTA revealed that 6 patients had endoleakage at the distal end of the triple-branched stent(0/110 patients [0.0%] vs. 6/90 patients [6.7%], P=0.022). The anticoagulation-related thromboembolism/bleeding events was significantly lower in group A than in group B(0/110 patients [0.0%] vs. 11/90 patients [11.1%], P=0.001). And postoperative aortic valve re-operation rate was significantly lower in group A (1/110 patients [0.9%] vs. 8/90 patients [8.9%], P=0.020). There was no significant difference in survival during the follow-up period (log-rank P>0.05).Conclusion: For middle-aged patients with acute DeBakey I AD, VSARR were associated with a lower rate of endoleakage at the distal end of the triple-branched stent, thromboembolism/bleeding events and aortic valve re-operation(vs. the Bentall procedure) .