The mid-term outcomes of aortic-root repair is not inferior to Bentall procedure in acute type-A aortic dissection

Abstract

ObjectiveBentall procedure used to be standard operation for involved aortic root in acute type A aortic dissection (ATAAD). But aortic root repair for preserving valve is still controversial in ATAAD. This study aimed to evaluate the midterm outcomes of aortic root repair by comparing with Bentall approach. MethodsA retrospective analysis of 1075 ATAAD patients with aortic root involvement was conducted. The patients were divided into aortic root repair group (n = 447) and Bentall group (n = 628). The propensity score matching analysis (PSMA) was used to adjust the baseline. ResultsThe median follow-up was 44 months (interquartile range, 17–65 months; range, 1–130 months). The 30-day mortality in the repair and replacement groups was 15.0 % and 12.9 % (P = 0.327) respectively; the late overall mortality was 15.9 % and 14.0 % (P = 0.394) respectively. The Kaplan-Meier 10-year survival and free-from-reoperation was 86.0 % and 92.5 % respectively in the repair group. After PSMA, the cumulative survival rate [Hazard Ratio (HR) 0.685; 95 % Confidence Interval (CI) 0.457–1.027; P = 0.747]) and reoperation rate (HR 0.308; 95 % CI 0.070–1.355; P = 0.157) was not significantly higher in the repair group than in the Bentall group. ConclusionThe mid-term outcome of aortic root repair is probably not inferior to Bentall procedure. Therefore, root repair is an alternative approach in ATAAD with the advantage of preserving native valve.