Abstract
There are debates regarding the optimal approach for AAAD involving the aortic root. We described a modified reinforced aortic root reconstruction approach for treating AAAD involving the aortic root. A total of 161 patients with AAAD involving the aortic root were treated by our modified reinforced aortic root reconstruction approach from January 1998 to December 2008. Key features of our modified approach were placement of an autologous pericardial patch in the false lumen, lining of the sinotubular junction lumen with a polyester vascular ring, and wrapping of the vessel with Teflon strips. Outcome measures included post-operative mortality, survival, complications, and level of aortic regurgitation. A total of 161 patients were included in the study (mean age: 43.3 1 15.5 years). The mean duration of follow-up was 5.1 1 2.96 years (2-12 years). A total of 10 (6.2%) and 11 (6.8%) patients died during hospitalization and during follow-up, respectively. Thirty-one (19.3%) patients experienced postoperative complications. The 1-, 3-, 5-, and 10-year survival rates were 99.3%, 98%, 93.8%, and 75.5%, respectively. There were no instances of recurrent aortic dissection, aortic aneurysm, or pseudoaneurysm during the entire study period. The severity of aortic regurgitation dramatically decreased immediately after surgery (from 28.6% to 0% grade 3-4) and thereafter slightly increased (from 0% to 7.2% at 5 years and 9.1% at 10 years). This modified reinforced aortic root reconstruction was feasible, safe and durable/effective, as indicated by its low mortality, low postoperative complications and high survival rate.
Highlights
Acute type A aortic dissection (AAAD) is associated with a very high mortality rate (1%-2% per hour after the onset of symptoms) if left untreated, and up to 20% of patients die before receiving medical attention [1,2,3]
Exclusion criteria were pathologies not suitable for aortic root reconstruction including aortic sinus aneurysm or aortic annulus dilatation; tears at the aortic root or in the coronary artery; coronary artery avulsion; moderate or severe aortic regurgitation caused by disorders other than dissection; and obvious aortic valve lesions
Echocardiography and contrast-enhanced computed tomographic (CT) scans were performed before discharge, 3 and 6 months after surgery, and annually thereafter to evaluate the degree of aortic valve function and cardiac function, observe whether any recurrent dissection, aneurysm, or pseudoaneurysm had developed, and measure the annulus, sinus of Valsalva (SOV), and sinotubular junction (STJ) lumen diameter
Summary
Acute type A aortic dissection (AAAD) is associated with a very high mortality rate (1%-2% per hour after the onset of symptoms) if left untreated, and up to 20% of patients die before receiving medical attention [1,2,3]. The current standard of care in the treatment of AAAD is emergency surgery, which is associated with an approximately 70% chance of survival, and high postoperative mortality and morbidity [1,2,4]. Various modifications of aortic valve sparing approaches have been described, including remodeling [9], Teflon remodeling [10], gluing dissected layers [11], and supracoronary replacement of the ascending aorta with root reconstruction [12]. Aortic valve-sparing can reduce short- and long-term complications associated with mechanical and biological replacement valves [13,14]
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