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

Abstract

Background \u2003Management 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 \u2003One 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 \u2003Patients from ARR group were younger than those from SCR group ( p \u2009<\u20090.0001). 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 \u2009=\u20090.636). The 10-year survivals of ARR and SCR groups were 64.8\u2009±\u200912.3% and 46.3\u2009±\u20095.8% ( p \u2009=\u20090.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups ( p \u2009=\u20090.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies ( p \u2009=\u20090.58). Reoperation on the distal aorta ( p \u2009=\u20090.012) and patent radiologic false lumen of the descending aorta ( p \u2009=\u20090.043) were independent risk factors of late death. Conclusion \u2003SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root.