Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection

J Thorac Cardiovasc Surg. 2022 Mar;163(3):900-910.e2. doi: 10.1016/j.jtcvs.2020.04.064. Epub 2020 May 4.

Abstract

Objective: The durability of root repair for acute type A aortic dissection is not well studied in the context of aortic insufficiency and stability of the sinuses of Valsalva. We compared clinical and functional outcomes in patients undergoing root repair and replacement for acute type A aortic dissection.

Methods: Of 716 patients undergoing surgery for acute type A aortic dissection, 585 (81.7%) underwent root repair and 131 (18.3%) underwent root replacement. Survival, cumulative incidence of reoperation, aortic insufficiency, and sinuses of Valsalva dilation were compared between the 2 groups.

Results: Survival at 1, 5, and 10 years was 84.1% versus 77.3%, 70.8% versus 69.2%, 57.6% versus 58.0% in the root repair and replacement groups, respectively (P = .69). Cumulative incidence of reoperation at 1, 5, and 10 years was 0.0% versus 0.8%, 1.4% versus 3.8%, and 3.4% versus 8.6% in the root repair and root replacement groups, respectively (P = .011). Multivariable Cox regression identified sinuses of Valsalva diameter 45 mm or more as a risk factor for proximal aortic reoperation (hazard ratio, 9.06; 95% confidence interval, 1.26-65.24). In a repeated-measures, linear, mixed-effects model, root replacement was associated with smaller follow-up of sinuses of Valsalva dimensions (β = -0.66, P < .001). In an ordinal longitudinal mixed model, root replacement was associated with lower severity of postoperative aortic insufficiency (β = -3.10, P < .001).

Conclusions: Survival is similar, but the incidence of aortic insufficiency and root dilation may be greater after root repair compared with root replacement for acute type A aortic dissection.

Keywords: aortic dissection; dilation; durability; root repair; root replacement.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aortic Aneurysm / diagnostic imaging
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / mortality
  • Aortic Dissection / surgery*
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Aortic Valve Insufficiency / diagnostic imaging
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Insufficiency / surgery*
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / mortality
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / surgery
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sinus of Valsalva / diagnostic imaging
  • Sinus of Valsalva / physiopathology
  • Sinus of Valsalva / surgery*
  • Time Factors
  • Treatment Outcome