Early aortic root remodeling after autologous adventitial inversion non-coronary sinus reconstruction for acute type a aortic dissection in a retrospective cohort study

Optimal management of the aortic root in acute type A aortic dissection (ATAAD) remains controversial, particularly when the sinuses are involved. We evaluated perioperative outcomes and early anatomical remodeling associated with Autologous Adventitial Inversion Non-Coronary Sinus Reconstruction. This single-center retrospective cohort included 41 patients with ATAAD involving the aortic root. Patients were classified according to the root reconstruction recorded at surgery: Autologous Adventitial Inversion Non-Coronary Sinus Reconstruction (Group A, n = 20) or heterogeneous conventional root reconstruction (Group B, n = 21). All operations were performed by the same surgeon, and serial echocardiographic measurements were obtained by a fixed measurement team blinded to the surgical technique. Perioperative outcomes were descriptively similar; no patient in either group died in hospital, required re-exploration for bleeding, or developed paraplegia, but event counts were too small to establish comparative safety. Early postoperative sinus of Valsalva diameter did not differ between groups ( P = 0.192). After Holm correction across 12 postoperative anatomical comparisons, Group A had a smaller sinus diameter at 1 month [Hodges-Lehmann location shift, -4.0 mm; 95% confidence interval (CI), -6.3 to -1.3; adjusted P = 0.034] and at approximately 12 months (-4.0 mm; 95% CI, -6.1 to -1.7; adjusted P = 0.015), whereas the 6-month comparison did not remain significant (adjusted P = 0.195). The baseline-to-follow-up change differed at 1 month (adjusted P = 0.026) but not at 6 or approximately 12 months (both adjusted P = 0.072). A sensitivity model adjusted for baseline sinus diameter and preoperative aortic flow velocity estimated a 3.63-mm larger approximately 12-month sinus diameter in Group B (95% CI, 1.26 to 6.00; P = 0.004). Aortic regurgitation grade did not differ between groups. In this small retrospective cohort, Autologous Adventitial Inversion Non-Coronary Sinus Reconstruction was feasible and was associated with a smaller sinus of Valsalva diameter at 1 and approximately 12 months after multiplicity correction. These exploratory anatomical findings do not establish safety equivalence, improved valve function, clinical benefit, or long-term durability.