Aortic root remodeling after surgical repair of acute type A aortic dissection using different anastomosis techniques.

Abstract

After surgical repair of acute type A aortic dissection (aTAAD), remodeling of the residual aortic segments is the key outcome parameter associated with late reoperation or aorta-related adverse events. In this study, we analyzed the surgical outcomes of aTAAD using either a telescopic or continuous anastomosis technique, focusing on their impact on aortic root remodeling during the longitudinal follow-up. Between 2012 and 2018, 112 surgical repairs of aTAAD with ascending aorta replacement and without aortic arch or aortic root replacement were performed. The medical records were reviewed retrospectively, and early and late outcomes were compared between the telescopic and continuous anastomosis techniques. The generalized estimating equation method was used to analyze the effects of different anastomosis techniques on serial aortic root remodeling. The telescopic anastomosis technique was used in 46 cases (41.1%), and the conventional continuous anastomosis technique was used in 66 cases (58.9%). There were no differences in in-hospital mortality or the incidence of major complications between the groups. The telescopic anastomosis group demonstrated stable postoperative regression of the aortic root diameter during follow-up. In contrast, the continuous anastomosis group showed a progressive dilatation of the aortic root. There was a trend toward better aortic root adverse event-free survival rates in the telescopic anastomosis group (P=.081). The telescopic anastomosis technique is a safe alternative to the continuous anastomosis technique in the surgical repair of aTAAD, with comparable early results. In addition, telescopic anastomosis was associated with beneficial aortic root remodeling in the medium term compared with continuous anastomosis.