Reply to the Editor

Abstract

We value receiving useful feedback in another letter to the Editor from Dr Hajj-Chahine.1Hajj-Chahine J. Fate of the preserved aortic root in acute type A aortic dissection.J Thorac Cardiovasc Surg. 2014; 147: 1112Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar We also appreciate his summary of our results2Rylski B. Beyersdorf F. Blanke P. Boos A. Hoffmann I. Dashkevich A. et al.Supracoronary ascending aortic replacement in patients with acute aortic dissection type A: what happens to the aortic root in the long run?.J Thorac Cardiovasc Surg. 2013; 146: 285-290Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar and his question regarding the factors predicting new-onset aortic root disease and aortic root reoperation after surgery for acute type A aortic dissection with preservation of the sinus segment. In our study of 119 patients with acute type A aortic dissection who underwent emergency ascending aortic replacement with sinus segment preservation, 26 patients exhibited evidence of new-onset aortic root disease during the follow-up period. Of these 26 patients, 10 required secondary proximal surgery. Dissection of all aortic sinuses of Valsalva was an independent predictor for aortic root reoperation (odds ratio [OR], 6.01; P < .05). However, this risk factor was not associated with new-onset aortic root disease (OR, 1.28; P = .62). A similar discrepancy was observed regarding dissection extending to the pelvic arteries, which was predictive of new-onset aortic root disease (OR, 3.57; P < .01) but was not predictive of root reoperation (OR, 1.65; P = .48). Although at first view, the predictors of new-onset aortic root disease might also predict aortic root repeat interventions, one should remember that this was an analysis of risk factors in 2 different groups, because not every case of aortic root disease requires repeat intervention. The risk factors for new-onset aortic root disorders and for root reoperations could, therefore, differ. The advantages of aortic root preservation, such as avoiding coronary artery manipulation, reducing the crossclamp time, eliminating the risk of prosthetic valve endocarditis, and avoiding the permanent need for anticoagulation with mechanical valve replacement, should be balanced against the risk of proximal reoperation during follow-up. Regarding the published experiences of centers favoring aortic root preservation in the setting of acute type A dissection, it has been our institution’s policy to consider more definitive aortic root repair for patients presenting with dissection of all sinuses, an aortic root diameter >47 mm, or dissection extending to the iliac arteries.2Rylski B. Beyersdorf F. Blanke P. Boos A. Hoffmann I. Dashkevich A. et al.Supracoronary ascending aortic replacement in patients with acute aortic dissection type A: what happens to the aortic root in the long run?.J Thorac Cardiovasc Surg. 2013; 146: 285-290Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 3Concistrè G. Casali G. Santaniello E. Montalto A. Fiorani B. Dell'Aquila A. et al.Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis.Ann Thorac Surg. 2012; 93: 450-455Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar, 4Ro S.K. Kim J.B. Hwang S.K. Jung S.H. Choo S.J. Chung C.H. et al.Aortic root conservative repair of acute type A aortic dissection involving the aortic root: fate of the aortic root and aortic valve function.J Thorac Cardiovasc Surg. 2013; 146: 1113-1118Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Fate of the preserved aortic root in acute type A aortic dissectionThe Journal of Thoracic and Cardiovascular SurgeryVol. 147Issue 3PreviewI read with great interest the article by Rylski and colleagues1 regarding the fate of unreplaced aortic root in patients with conservative aortic root repair for acute type A aortic dissection. By retrieving data concerning 119 patients undergoing supracoronary ascending aortic replacement for acute type A aortic dissection, they found that dissection of all aortic sinuses of Valsalva at the index procedure was an independent predictor for aortic root reoperation (odds ratio, 3.57; 95% confidence interval, 1.36-9.35; P < .01). Full-Text PDF