Valve-sparing aortic root replacement (remodeling/reimplantation) in acute type A dissection

• Published in: The Annals of thoracic surgery Vol. 70; no. 1; pp. 21 - 24
• Main Authors: Leyh, Rainer G, Schmidtke, Claudia, Bartels, Claus, Sievers, Hans-Hinrich
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2000; Elsevier Science
• Subjects: Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortic Valve; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the aorta; Female; Humans; Male; Medical sciences; Middle Aged; Time Factors; Ultrasonography; Vascular Surgical Procedures - methods; Vascular disease; Dissecting aneurysm; Human; Treatment; Surgery; Cardiovascular disease; Aorta; Technique; Replantation; Aortic disease
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(00)01253-4

Background. High reoperation rates after supracommissural tube graft replacement for acute type A dissection due to sinus of Valsalva dilation have been reported. Valve-sparing operations focusing on the replacement of the sinus of Valsalva are an appealing alternative. The applicability of these techniques in acute type A dissection remains debatable and results are limited. Methods. From 1992 to 1998, 20 patients with acute type A dissection received a valve-sparing aortic root replacement. Two different types of aortic valve-sparing operations were performed: the remodeling technique in 11 patients and the reimplantation technique in 9 patients. Patients were followed for 26 ± 18 months. Echocardiographic studies were performed every 6 months. Results. There were 2 early postoperative deaths and no late death, no reoperation, and no thromboembolic events. The latest echocardiographic studies of the 18 survivors showed a competent valve in 12 and a trivial aortic valve insufficiency in 6 patients. The mean aortic valve pressure gradient was 4.3 ± 1.3 mm Hg. Conclusions. These midterm results support the surgical strategy of valve-sparing aortic root replacement in patients with acute type A dissection.