Fate of Preserved Aortic Root Following Acute Type A Aortic Dissection Repair

Abstract

We examined the long-term fate of the preserved aortic root after emergent repair of acute Type A aortic dissection. 144 patients (60% males, mean age 60.5 years) underwent supracoronary ascending aortic replacement for acute Type A aortic dissection. Long-term survival, as well as growth, reoperation, and adverse events of the aortic root (rupture, pseudoaneurysm, and persistent dissection) were retrospectively assessed. Operative mortality was 9%, and overall survival at 1, 5, and 10 years was 87.8%, 76.4%, and 64.6%, respectively. Reoperation on the proximal aorta was performed in 16 patients (12.2%) within a median of 2.45 years post-operatively. Indications were severe aortic insufficiency (AI) (n = 6), aortic root pseudoaneurysm (n = 8), pseudoaneurysm with severe AI (n = 1), and persistent dissection with severe AI (n = 1). The aortic root grew at 0.2mm/year (interquartile range 0-0.8). Among survivors (n = 131), 28 patients (21.3%) reached aortic root diameter ≥ 45 mm (mean diameter 47.6 mm, range 45-54 mm). Survival free from proximal aortic reoperation at 1, 5, and 10 years was 96.6%, 94.5%, and 92.2%, respectively. No non-reoperated patient-despite persistent, unoperated enlargement or distortion or pseudoaneurysm of the aortic root-developed free rupture or fistula to a cardiac chamber. Root-sparing ascending aortic replacement for acute Type-A aortic dissection showed satisfactory long-term outcomes with relatively low rates of re-intervention or serious aortic root adverse events despite dilatation and irregularity of aortic root contour. Dense adhesions from prior surgery, proximal aortic suture line, and Teflon felt seem to discourage free rupture or fistulization.