Thorac Cardiovasc Surg
DOI: 10.1055/s-0040-1718937
Original Cardiovascular

Aortic Root Remodeling in Acute Aortic Dissection

1  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
,
Irem Karliova
1  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
,
Lennart Froede
1  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
,
Christian Giebels
1  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
,
Takashi Kunihara
1  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
,
Hans-Joachim Schäfers
1  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
› Author Affiliations

Abstract

Objectives To evaluate the long-term results of remodeling in acute aortic dissection type A (AADA) to define operative risk and root and valve stability.

Methods Between October 1995 and December 2018, a total of 352 patients were treated surgically for AADA. Of these, 90 patients with AADA (<2 weeks from onset; age: 57 ± 15 years; 70 males) with a root diameter of >43 to 45 mm (depending on patient size) (48 ± 4.1 mm) underwent aortic root remodeling and were analyzed further. As the control group, we chose the patients with normally sized aortic roots who had been treated by tubular replacement only (n = 227). Other procedures were performed in 35 cases.

Results Early mortality was 9% in the remodeling group versus 15% in the tubular ascending aortic replacement (TAR). Actuarial survival at 10 and 15 years was 68 ± 5% and 58.3 ± 6.4%, respectively, in the root remodeling group versus 68 ± 4% and 66 ± 4% in the TAR group (p = 0.99). Freedom from reoperation on the aortic valve or root was 95 ± 3% at 10 years and at 89 ± 6% at 15 years. Freedom from proximal reoperation after TAR at 10 and 15 years was 93 ± 3% and 91 ± 3% (n = 31 patients at risk), respectively, not statistically different from that after remodeling (p = 0.75).

Conclusions The long-term stability of aortic root remodeling for enlarged roots with AADA was comparable to TAR preserving a normal aortic root.



Publication History

Received: 08 April 2020

Accepted: 31 August 2020

Publication Date:
01 December 2020 (online)

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