Clinical practice and thoughts on the strategy of root reconstruction for Stanford type A aortic dissection

Abstract

The strategy of root reconstruction for Stanford type A aortic dissection (AAD) includes resection of the intimal tear site, correction of concomitant aortic valve dysfunction and amendment of coronary lesion. Supracommissural tube graft replacement is a well-adopted and convenient procedure for most patients, although its application is limited when distinct sinus expansion and severe intimal damage is present. Composite valve conduit replacement (Bentall procedure) is suitable for patients with overt sinus damage. However, a fraction of patients with functional aortic valve will be unnecessarily put into risks for prosthetic complications. Valve-sparing aortic root replacement (VSRR), which includes aortic root remodeling (Yacoub procedure) and reimplantation (David procedure) techniques, has the advantage of retaining autologous aortic valve while guaranteeing resection of damaged vessel segments.The Yacoub procedure is relatively convenient but harbors long-term risk for annulus expansion, while the David procedure demonstrates long-term benefit but may be too demanding to be operated in emergent scenario as AAD. The last decade has witnessed worldwide endeavors to investigate the treatment strategy for aortic root, especially the VSRR approach. The preliminary results are encouraging and demonstrating improvements for both mid- and long-term outcomes of AAD, which enables standardized and personalized surgical management for these patients.