Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection

AORTA

article

Tyler M. Gunn¹  Sotiris C. Stamou¹  Nicholas T. Kouchoukos²  Kevin W. Lobdell³  Kamal Khabbaz⁴  Lawrence H. Patzelt⁵  Robert C. Hagberg⁶ 

[1] Department of Cardiothoracic Surgery, Baystate Medical Center;Division of Cardiothoracic Surgery, Missouri Baptist Medical Center;Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center;Division of Cardiothoracic Surgery, Department of Surgery and The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School;Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute;Department of Cardiac Surgery, Hartford Hospital

关键词: Aorta;    Aortic aneurysm;    Aortic root;    Aortic valve;   

DOI  :  10.12945/j.aorta.2016.14.039

来源: Thieme

【 摘 要 】

Background: The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure. Methods: All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution’s Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed. Results: The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035). Conclusions: The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.

【 授权许可】

Unknown