Supracoronary aortic replacement for acute type A aortic dissection: A risk-factor for developing a late aortic root aneurysm?

Objective: The study aim was to detect the long-term durability of supracoronary aortic replacement for root aneurysm in patients with acute type A aortic dissection (ATAAD).

Methods: Between 2000 and 2011, 164 consecutive patients (37% female, mean age 61.4 ± 12.7) with ATAAD underwent ascending aortic replacement. 102 (62.6%) patients of this cohort were treated with preserving the aortic root by supracoronary aortic replacement with a dacron vascular prosthesis provided that the root was not involved in the dissection and no aortic insufficiency was present. Additionally, hemi arch (n = 60, 58.8%) or total arch replacement (n = 14, 13.7%) were performed. The maximum follow-up was 11.67 years with a mean of 3.63 ± 2.88 years. Patients were followed-up by questionnaire and telephone interview (100% complete). The aortic root diameter was evaluated by serial transthoracic echocardiography and/or CT scans (69.5% complete).

Results: The 30-day mortality rate was 15.7% (n = 16). The hospital stay was 11.3 days (range 1 – 41 days). The mean diameter of the aortic root was 3.80 ± 0.56 cm at last follow-up. The majority of the patients (n = 31, 75.6%) revealed a normal root diameter (≤40 mm). Another 22.0% (n = 9) of this cohort showed a root diameter between 40 to 50 mm. Actuarial survival at 1, 3 and 5 years were 74.0%, 65.5%, and 54.5%, respectively. Freedom from reoperation for postoperative aortic root aneurysm at 1, 3 and 5 years was 100%, 100%, and 95.5% respectively.

Conclusion: This study demonstrates that supracoronary aortic replacement in patients with ATAAD can be performed safely and shows very good mid-term results. The long-term reliability of this technique must still be proven.