Durability and safety of David V valve-sparing root replacement in acute type A aortic dissection

The Journal of Thoracic and Cardiovascular Surgery

Bradley G. Leshnower¹  Joshua M. Rosenblum² 

[1] Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Ga;Division of Cardiac Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga

关键词: type A aortic dissection;    valve-sparing root replacement;    David V;   

DOI  :  10.1016/j.jtcvs.2018.10.059

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

BackgroundValve-sparing root replacement (VSRR) is an attractive option in type A aortic dissection (TAAD) repair for a young patient with normal cusp anatomy, but conventional root replacement using a composite valved-conduit (ROOT) remains the gold standard in this emergent clinical setting. We examine the long-term safety and durability of the David V VSRR compared with ROOT in TAAD repair.MethodsFrom March 2004 to April 2017, 136 patients underwent repair of acute TAAD using either ROOT (n = 77; 56.6%) or VSRR (n = 59; 43.4%). Annual echocardiograms were performed for follow-up in VSRR patients. Univariable regression, Kaplan–Meier, and competing risk analyses were performed.ResultsPreoperative characteristics were similar between groups, except that VSRR patients were younger (mean age 43.5 ± 11.4 years VSRR vs 50.4 ± 3.0 years ROOT; P = .001). Both groups had similar rates of preoperative malperfusion or shock (29.3% VSRR vs 37.0% ROOT; P = .35) and ≥3+ aortic insufficiency (63% VSRR vs 76.8% ROOT). Thirty-day mortality in the VSRR group was 2/59 (3.4%) and 11/77 in the ROOT group (14.3%; P P = .002). The incidence of aortic reintervention was similar between groups (20%-23% at 5 years; P = .81). At 9 years of follow-up, 5/52 (9.6%) VSRR patients had ≥2+ aortic insufficiency, and 1 patient required valve reintervention.ConclusionsIn highly-selected patients, the David V VSRR provides a safe repair of acute TAAD with concomitant root pathology and valve insufficiency. In our center, the incidence of valve-related reintervention at long-term follow-up is low after emergent repair.

【 授权许可】

Unknown