Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 146; no. 6; pp. 1456 - 1460
• Main Authors: Dell'Aquila, Angelo M., MD, Concistrè, Giovanni, MD, Gallo, Alina, MD, Pansini, Stefano, MD, Piccardo, Alessandro, MD, Passerone, Giancarlo, MD, Regesta, Tommaso, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.12.2013
• Subjects: Acute Disease; Age Factors; Aged; Aneurysm, Dissecting - etiology; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm - etiology; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Aortic Valve - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Cardiothoracic Surgery; Chi-Square Distribution; Disease-Free Survival; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Marfan Syndrome - complications; Middle Aged; Multivariate Analysis; Postoperative Complications - mortality; Postoperative Complications - surgery; Proportional Hazards Models; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; RR; 35; AAD; 26; deep hypothermic circulatory arrest; acute type A aortic dissection; DHCA; relative risk
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.09.049

Objective The objective of this study was to examine the fate of the native aortic root after replacement of the ascending aorta to treat acute type A aortic dissection. Methods Between June 1985 and January 2010, 319 consecutive patients (mean age, 63 ± 11 years) with acute type A aortic dissection underwent replacement of the ascending aorta with preservation of the aortic root. The aortic valve was also replaced in 21 of these patients (7%). The intervention was extended to the aortic arch in 210 patients (66%), of whom 173 (54%) underwent hemiarch replacement, and 37 (12%), total arch replacement. Results There were 109 (34%) in-hospital deaths. Of the 210 discharged patients, survival was 95%, 58%, and 27% at 1, 10, and 23 years, respectively. Freedom from reoperation on the proximal aorta was reported by 97%, 92%, and 82% patients at 5, 10, and 23 years, respectively. Twelve patients were reoperated for aortic root dilatation and 2 died during reoperation. Univariate and multivariate Cox regression analyses revealed that significant risk factors for proximal reoperation were age <60 years ( P  = .005; relative risk, 1.94) and Marfan syndrome ( P  = .011; relative risk, 2.76). At follow-up, 15 patients (11%) had an aortic root diameter of >45 mm, but they were not reoperated. Conclusions For acute type A aortic dissection, replacement of the ascending aorta with root preservation shows long-term effectiveness with low reoperation and aortic root dilatation rates.