Preservation of the Aortic Root During Type A Aortic Dissection Surgery: An Effective Strategy?

AORTA

article

Simon Dang Van¹  Jihed Laribi¹  Frédéric Pinaud¹  Patrice Binuani¹  Serge Willoteaux²  Christophe Baufreton¹  Olivier Fouquet¹ 

[1] Department of Cardiac Surgery, University Hospital of Angers;Department of Radiology, University Hospital of Angers;Mitovasc Institute INSERM U1083 UMR-CNRS 6214, University Hospital of Angers

关键词: aortic dissection;    aortic root;    late reoperation;    supracoronary aortic replacement;   

DOI  :  10.1055/s-0041-1725074

来源: Thieme

【 摘 要 】

Background Management of the aortic root during acute Type A aortic dissection (TAAD) repair remains controversial in term of long-term evolution and reoperation. The aim of this study was to assess the long-term outcomes of the aortic root after conservative management during primary surgery.Methods One hundred sixty-four consecutive patients were included in this monocentric retrospective study. The primary endpoint was reoperation on the aortic root during long-term follow-up. Forty-six patients had aortic root replacement (ARR) and 118 had supracoronary aortic replacement (SCR). The 10-year survival, occurrence of significant aortic regurgitation, and radiologic aortic root dilatation in each group were assessed during follow-up.Results Patients from ARR group were younger than those from SCR group (p < 0.0001). Median follow-ups of ARR group and SCR group are 4.4 (interquartile range [IR]: 2.6–8.3) and 6.15 (IR: 2.8–10.53) years, respectively. Reoperation of the aortic root during long-term follow-up was similar in both groups (ARR group: 5.1%, SCR group: 3.3%, p = 0.636). The 10-year survivals of ARR and SCR groups were 64.8 ± 12.3% and 46.3 ± 5.8% (p = 0.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups (p = 0.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies (p = 0.58). Reoperation on the distal aorta (p = 0.012) and patent radiologic false lumen of the descending aorta (p = 0.043) were independent risk factors of late death.Conclusion SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root.

【 授权许可】

Unknown