Partial aortic root remodeling for root reconstruction in patients with acute type A dissection

Abstract

In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece (4-5 cm) of collagen coated woven polyester vascular prosthesis was trimmed with one or two "tongues" to reconstruct the non-coronary sinus and/or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4±3.6 months. In-hospital mortality was only 5.0% (2/40); furthermore, 3 (8.6%) patients underwent re-operation of the aortic valve and 2 (5.7%) patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.

Keywords: aortic dissection; aortic root remodeling; valve function.

Fig. 1. Partial aortic root remodeling for root reconstruction in patients with acute type A dissection. A Dacron tube is performed to resuspend the aortic valve and reconstitute the sinuses. A: A Dacron tube with 1 tongue-shaped process was then performed to resuspend the aortic valve and reconstitute the sinuses. B: A Dacron tube with 2 tongue-shaped processes was then performed to resuspend the aortic valve and reconstitute the sinuses.

Fig. 2. Actuarial survival after partial root remodeling operations. The average survival rate at 1, 5, and 10 years after partial root remodeling operations.

Fig. 3. Freedom from aortic valve replacement. Freedom from valve replacement at 1, 5, and 10 years after partial root remodeling operations.