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CC BY 4.0 · Aorta (Stamford) 2021; 09(02): 067-075
DOI: 10.1055/s-0041-1725074
Original Research Article

Preservation of the Aortic Root During Type A Aortic Dissection Surgery: An Effective Strategy?

Simon Dang Van 
1   Department of Cardiac Surgery, University Hospital of Angers, Angers, France
,
Jihed Laribi
1   Department of Cardiac Surgery, University Hospital of Angers, Angers, France
,
Frédéric Pinaud
1   Department of Cardiac Surgery, University Hospital of Angers, Angers, France
,
Patrice Binuani
1   Department of Cardiac Surgery, University Hospital of Angers, Angers, France
,
Serge Willoteaux
2   Department of Radiology, University Hospital of Angers, Angers, France
,
Christophe Baufreton‡   *
1   Department of Cardiac Surgery, University Hospital of Angers, Angers, France
3   Mitovasc Institute INSERM U1083 UMR-CNRS 6214, University Hospital of Angers, Angers, France
,
Olivier Fouquet‡   *
1   Department of Cardiac Surgery, University Hospital of Angers, Angers, France
3   Mitovasc Institute INSERM U1083 UMR-CNRS 6214, University Hospital of Angers, Angers, France
› Author Affiliations Funding None.
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Abstract

Background Management of the aortic root during acute Type A aortic dissection (TAAD) repair remains controversial in term of long-term evolution and reoperation. The aim of this study was to assess the long-term outcomes of the aortic root after conservative management during primary surgery.

Methods One hundred sixty-four consecutive patients were included in this monocentric retrospective study. The primary endpoint was reoperation on the aortic root during long-term follow-up. Forty-six patients had aortic root replacement (ARR) and 118 had supracoronary aortic replacement (SCR). The 10-year survival, occurrence of significant aortic regurgitation, and radiologic aortic root dilatation in each group were assessed during follow-up.

Results Patients from ARR group were younger than those from SCR group (p < 0.0001). Median follow-ups of ARR group and SCR group are 4.4 (interquartile range [IR]: 2.6–8.3) and 6.15 (IR: 2.8–10.53) years, respectively. Reoperation of the aortic root during long-term follow-up was similar in both groups (ARR group: 5.1%, SCR group: 3.3%, p = 0.636). The 10-year survivals of ARR and SCR groups were 64.8 ± 12.3% and 46.3 ± 5.8% (p = 0.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups (p = 0.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies (p = 0.58). Reoperation on the distal aorta (p = 0.012) and patent radiologic false lumen of the descending aorta (p = 0.043) were independent risk factors of late death.

Conclusion SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root.

Keywords

aortic dissection - aortic root - late reoperation - supracoronary aortic replacement

* The last two authors contributed equally to the study.




Publication History

Received: 28 February 2020

Accepted: 02 October 2020

Article published online:
07 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Parikh N, Trimarchi S, Gleason TG. et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg 2017; 153 (04) S74-S79
    CrossrefPubMedGoogle Scholar
  • 2 Kallenbach K, Oelze T, Salcher R. et al. Evolving strategies for treatment of acute aortic dissection Type A. Circulation 2004; 110 (11, Suppl 1): II243-II249
    CrossrefPubMedGoogle Scholar
  • 3 Montalvo J, Razzouk A, Wang N. et al. Aortic root surgery does not increase the operative risk of acute Type A aortic dissection. Am Surg 2011; 77 (01) 88-92
    CrossrefPubMedGoogle Scholar
  • 4 Kunihara T, Neumann N, Kriechbaum SD, Aicher D, Schäfers HJ. Aortic root remodeling leads to good valve stability in acute aortic dissection and preexistent root dilatation. J Thorac Cardiovasc Surg 2016; 152 (02) 430-436.e1
    CrossrefPubMedGoogle Scholar
  • 5 Esaki J, Leshnower BG, Binongo JN. et al. Reoperative aortic root replacement: outcome in a contemporary series. J Thorac Cardiovasc Surg 2017; 154 (03) 800-808.e3
    CrossrefPubMedGoogle Scholar
  • 6 Subramanian S, Leontyev S, Borger MA, Trommer C, Misfeld M, Mohr FW. Valve-sparing root reconstruction does not compromise survival in acute Type A aortic dissection. Ann Thorac Surg 2012; 94 (04) 1230-1234
    CrossrefPubMedGoogle Scholar
  • 7 Estrera AL, Miller III CC, Villa MA. et al. Proximal reoperations after repaired acute Type A aortic dissection. Ann Thorac Surg 2007; 83 (05) 1603-1608 , discussion 1608–1609
    CrossrefPubMedGoogle Scholar
  • 8 de Brux JL, Subayi JB, Pegis JD, Pillet J. Retrograde cerebral perfusion: anatomic study of the distribution of blood to the brain. Ann Thorac Surg 1995; 60 (05) 1294-1298
    CrossrefPubMedGoogle Scholar
  • 9 David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1992; 103 (04) 617-621 , discussion 622
    CrossrefPubMedGoogle Scholar
  • 10 Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg 1993; 105 (03) 435-438
    CrossrefPubMedGoogle Scholar
  • 11 Roman MJ, Devereux RB, Kramer-Fox R, O'Loughlin J. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64 (08) 507-512
    CrossrefPubMedGoogle Scholar
  • 12 Westaby S, Saito S, Katsumata T. Acute Type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg 2002; 73 (03) 707-713
    CrossrefPubMedGoogle Scholar
  • 13 Sievers HH, Richardt D, Diwoky M. et al. Survival and reoperation after valve-sparing root replacement and root repair in acute Type A dissection. J Thorac Cardiovasc Surg 2018; 156 (06) 2076-2082.e2
    CrossrefPubMedGoogle Scholar
  • 14 Hysi I, Juthier F, Fabre O. et al. Aortic root surgery improves long-term survival after acute Type A aortic dissection. Int J Cardiol 2015; 184: 285-290
    CrossrefPubMedGoogle Scholar
  • 15 Di Eusanio M, Trimarchi S, Peterson MD. et al. Root replacement surgery versus more conservative management during Type A acute aortic dissection repair. Ann Thorac Surg 2014; 98 (06) 2078-2084
    CrossrefPubMedGoogle Scholar
  • 16 Berretta P, Patel HJ, Gleason TG. et al. IRAD experience on surgical Type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg 2016; 5 (04) 346-351
    CrossrefPubMedGoogle Scholar
  • 17 Erbel R, Aboyans V, Boileau C. et al; ESC Committee for Practice Guidelines, The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014; 35 (41) 2873-2926
    CrossrefPubMedGoogle Scholar
  • 18 Saczkowski R, Malas T, Mesana T, de Kerchove L, El Khoury G, Boodhwani M. Aortic valve preservation and repair in acute Type A aortic dissection. Eur J Cardiothorac Surg 2014; 45 (06) e220-e226
    CrossrefPubMedGoogle Scholar
  • 19 Halstead JC, Spielvogel D, Meier DM. et al. Composite aortic root replacement in acute Type A dissection: time to rethink the indications?. Eur J Cardiothorac Surg 2005; 27 (04) 626-632 , discussion 632–633
    CrossrefPubMedGoogle Scholar
  • 20 Rylski B, Bavaria JE, Beyersdorf F. et al. Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome. Circulation 2014; 129 (13) 1381-1386
    CrossrefPubMedGoogle Scholar
  • 21 Ro SK, Kim JB, Hwang SK. et al. Aortic root conservative repair of acute Type A aortic dissection involving the aortic root: fate of the aortic root and aortic valve function. J Thorac Cardiovasc Surg 2013; 146 (05) 1113-1118
    CrossrefPubMedGoogle Scholar