Sinus Preservation in Acute Type A Aortic Dissection: Glue vs. Neomedia—Propensity-Matched Outcomes from a Two-Center Cohort of Patients Under 65

Background: Among patients who undergo surgery for type A aortic dissection with involvement of the aortic root, sinus preservation is a common procedure that can be performed using various methods. Here, we aim to compare the long-term outcomes of two surgical techniques: the implantation of a neomedia and the use of a two-component glue.

Methods: Between 2005 and 2022, data from patients under 65 years of age who underwent sinus preservation for acute type A aortic dissection at two tertiary centers were retrospectively gathered. An anonymized registry was created. Patients were stratified into two groups according to the reconstruction technique used. In the glue group, a two-component glue was applied between the dissected layers, whereas in the neomedia group, the dissected root was reinforced with the implantation of a PTFE felt between the layers. A propensity-matched analysis, based on root diameter at the time of dissection, comorbidities, and malperfusion, was performed to address the diversity of clinical presentations. Kaplan-Meier survival estimates and the incidence of reintervention, using death as a competing event, were obtained.

Results: Five hundred forty-four patients underwent sinus preservation for aTAAD, and 155 propensity-matched pairs were obtained. Early postoperative outcomes were similar between both groups, both before and after matching: stroke 11.6% (18) versus 20% (31), p = 0.062; resternotomy 12.3% (19) versus 6.5% (10), p = 0.127; mortality 9.7% (15) versus 1% (17), p = 0.852 in the neomedia and glue groups, respectively, after matching. Kaplan-Meier survival estimates at 10 years were similar in both groups, regardless of the matched analysis: 77.1% (95%CI: 70.1–84.7) versus 65.7% (95%CI: 59.3–72.8), p = 0.4. The incidence of reintervention at 10 years was significantly higher following the use of glue, 19% (95%CI: 11–28) versus 9.1% (95%CI: 3.9–17), p < 0.001, and was similar in the matched analysis.

Conclusion: Neomedia provides a more durable and stable reconstruction of the dissected layers of the aortic root following acute type A aortic dissection as demonstrated by the lower incidence of reintervention. Rates of proximal reoperation could be significantly reduced with a broader use of neomedia when compared with solely glue-based strategies.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025