Aortic root conservative repair of acute type A aortic dissection involving the aortic root: fate of the aortic root and aortic valve function.
- Authors
- Ro, Sun Kyun; Kim, Joon Bum; Hwang, Su Kyung; Jung, Sung Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won
- Issue Date
- 2013
- Publisher
- MOSBY-ELSEVIER
- Citation
- JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, v.146, no.5, pp.1113 - 1118
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
- Volume
- 146
- Number
- 5
- Start Page
- 1113
- End Page
- 1118
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/163768
- DOI
- 10.1016/j.jtcvs.2012.08.055
- ISSN
- 0022-5223
- Abstract
- Objectives: Despite many studies about aortic valve function and aortic root geometry after conservative aortic root repair of acute type A aortic dissection, the results are not always consistent or conclusive. This study aims to evaluate aortic root diameter and aortic valve function after surgery for acute type A aortic dissection involving the aortic root. Methods: A retrospective review was performed of 196 consecutive patients (age, 56.9 +/- 11.4 years; 96 men) who underwent conservative aortic root repair including sinotubular junction resuspension for the management of acute type A aortic dissection involving the aortic root. Results: The 30-day mortality rate was 5.1% (n = 10). During a median follow-up period of 45.3 +/- 36.4 months, there were 28 deaths and 11 cases of aortic reoperation (proximal reoperation in 1 and distal reoperation in 10). Of the 6-month survivors (n = 177, 90.3%), echocardiography and computed tomography were performed in the late period (˃6 months) on 115 (65.0%) and 138 (78.0%), respectively. Significant aortic regurgitation (greater than grade 2+) or root dilatation (˃45 mm) was observed in 5 and 19 patients, respectively. Freedom from aortic regurgitation (greater than grade 2+) or root dilatation (˃45 mm) at 5 years was 84.6% +/- 3.9%. On the Cox regression analysis, the maximal aortic root diameter at initial presentation was the only significant predictor of aortic regurgitation and aortic root dilatation (hazard ratio, 1.10; 95% confidence interval, 1.02-1.19; P = .014). Conclusions: Conservative aortic root repair of acute type A aortic dissection demonstrates acceptable long-term clinical outcomes. However, more aggressive approaches should be considered for patients who have aortic root dilatation because of the risk of developing a root aneurysm after surgery.
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