Sparing the aortic root in acute aortic dissection type A: risk reduction and restored integrity of the untouched root

Abstract

Objectives: The purpose of the study was to evaluate the operative outcome and the risk of retained proximal aortic tissue following the root-sparing (RS) technique in acute aortic dissection type A (AADA).

Methods: Between 2002 and 2014, 338 patients underwent repair of AADA; 74% of those were performed with the RS technique and 26% with root replacement (RR). The mean age was 62.4 ± 13.4 years (69% male) in the RS group and 56.1 ± 13.1 years (76% male) in the RR group (P < 0.001). Aortic insufficiency 2+ or higher was present in 35% (RS) and 72% (RR, P < 0.001), and bicuspid morphology in 1% (RS) and 16% (RR, P < 0.001).

Results: Cardiopulmonary bypass time and cross-clamp time were significantly lower in the RS group (199 ± 71 vs 274 ± 110 min; 108 ± 46 vs 169 ± 55 min; P < 0.001 each), while no difference was seen with regard to distal operative extent, the use of circulatory arrest and adjunct protection strategies. The postoperative incidence of bleeding (18 vs 34%; P = 0.003), low cardiac output (14 vs 29%; P = 0.002) and sepsis/systemic inflammatory response syndrome (5 vs 12%; P = 0.037) were higher after RR, whereas mortality and survival did not differ between the groups. The aortic root grows at 0.40 ± 0.13 mm/year after AADA and thus, the need for potential reoperation was estimated at greater than 40 years. Freedom from root events after 5 and 10 years of follow-up was 97 and 92% in the RS group, and 100% each in RR group, respectively.

Conclusions: Both RS and RR procedures can be performed with an acceptable postoperative outcome and late survival in AADA. The RS approach can safely be performed with excellent results in acute survival and stabilizes the native root for a long period of time.

Keywords: Aortic dissection; Aortic events; Aortic root; Natural history; Root replacement; Supracoronary ascending replacement.