The Aortic Root in Acute Type A Dissection: Rationale and Outcome for an Increased Use of Root Replacement

Abstract

Management of the aortic root in acute type A dissection remains challenging and controversial and the appropriate strategy depends on a number of patient and anatomic factors. Valve resuspension is simple and easy to perform and may be appropriate in a majority of patients without aortic root pathology. Moderate to severe aortic insufficiency, annuloaortic ectasia with annular diameter >27 mm, connective tissue disorders such as Marfan’s syndrome, and the use of gelatin-resorcinol-formaldehyde glue in aortic root repair, have all been identified as risk factors for proximal reoperation. In the presence of the above anatomic risk factors or significant root pathology, an aortic root replacement should be performed. A biological valve-graft conduit can be used if systemic anticoagulation is a concern. In experienced hands and in stable patients with normal aortic valve anatomy, a valve-sparing reimplantation procedure may be considered.