Aortic root reinforcement combined with vascular rafts eversion and built-in procedure for Acute Type A Aortic dissection surgery

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Abstract Background Acute type A aortic dissection (ATAAD) is a life-threatening disease with high mortality. Surgery remains the gold standard for the treatment of ATAAD. However, ATAAD surgery, especially the aortic root reinforcement technique, is still a challenge for surgeons. Methods All Stanford type A aortic dissection patients undergoing surgery in our hospital from January 2020 to December 2021 were retrospectively entrolled. These patients were divided into three groups according to the surgical procedures of aortic rot: continuous aortic root suture group (CARS group); "intermittent mattress type built-in skirt forming method" group, which was created by our group (XJ-procedure group), aortic root replacement group (Bentall group). The primary outcomes were 30-day mortality and incidence of recurrent dissection of aortic root (before dis-charge, 3 and 6 months of follow-up). The secondly outcomes were the rate of reoperation for aortic root bleeding, the incidence of pseudoaneurysms and the severe aortic valve regurgitation (the residual aortic valve regurgitation greater than grade 2+) rate before discharge, 3 and 6 months of follow-up. Results A total of 221 patients were entrolled in this study, including 69, 114 and 38 in CARS group, XJ-procedure group and Bentall group, respectively. The total operation time in the CARS group, XJ-procedure group and Bentall group were 391.74±74.05 minutes, 371.59±79.36minutes and 427.76±100.78 minutes, respectively (P=0.001, Pa=0.108, Pb=0.001). The overall 30-day mortality rate was 6.8% (15/221), 7.2% (5/69), 7.0% (8/114) and 5.3% (2/38) for all patients, CARS group, XJ-procedure group and Bentall group, respectively. In the CARS group, the incidence of recurrent dissection of aortic root was much lower in the XJ-procedure group than the CARS group before discharge (1.8% versus 10.6%), 3 months (9.4% versus 0%) and 6 months (7.8% vs 0%) follow-up, respectively. The rates of reoperation for aortic root bleeding in the CARS group, XJ-procedure group and Bentall group were 4.3%, 0.9%, and 2.6%, respectively (P=0.306, Pa=0.151, Pb=0.439). In the CARS group, the incidence of pseudoaneurysm was 3.0%,3,1%,3.0% before discharge, at 3 months and 6 months follow-up. In the XJ-procedure group, there was no reported pseudoaneurysm. The residual severe aortic valve regurgitation incidence was much lower in the XJ-procedure group than the CARS group at 3 months (0.9% versus 4.7%) and 6 months (0.9% versus 4.7%) follow-up, respectively. Compared with the traditional procedure, the XJ-procedure does not increase the perioperative mortality and reduces the incidence of aortic root complications. Conclusion XJ-procedure is a safe and effective aortic root reinforcement technique for ATAAD surgery and reduces aortic root complications by reinforcing the fragile aortic root tissue.