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. 2022 Feb 21;34(3):453-461.
doi: 10.1093/icvts/ivab324.

Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection

Mikko Jormalainen  1 , Risto Kesävuori  2 , Peter Raivio  1 , Antti Vento  1 , Caius Mustonen  3 , Hannu-Pekka Honkanen  3 , Stefano Rosato  4 , Jarmo Simpanen  1 , Kari Teittinen  1 , Fausto Biancari  1   5 , Tatu Juvonen  1   3
Affiliations

Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection

Mikko Jormalainen et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: We investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD).

Methods: Patients who underwent surgery for acute type A aortic dissection from 2005 to 2018 at the Helsinki University Hospital, Finland, were included in this analysis. Late mortality was evaluated with the Kaplan-Meier method and proximal aortic reoperation, i.e. operation on the aortic root or aortic valve, with the competing risk method.

Results: Out of 309 patients, 216 underwent supracoronary ascending aortic replacement and 93 had aortic root replacement. At 10 years, mortality was 33.8% after aortic root replacement and 35.2% after ascending aortic replacement (P = 0.806, adjusted hazard ratio 1.25, 95% confidence interval, 0.77-2.02), and the cumulative incidence of proximal aortic reoperation was 6.0% in the aortic root replacement group and 6.2% in the ascending aortic replacement group (P = 0.65; adjusted subdistributional hazard ratio 0.53, 95% confidence interval 0.15-1.89). Among 71 propensity score matched pairs, 10-year survival was 34.4% after aortic root replacement and 36.2% after ascending aortic replacement surgery (P = 0.70). Cumulative incidence of proximal aortic reoperation was 7.0% after aortic root replacement and 13.0% after ascending aortic replacement surgery (P = 0.22). Among 102 patients with complete imaging data [mean follow-up, 4.7 (3.2) years], the estimated growth rate of the aortic root diameter was 0.22 mm/year, that of its area 7.19 mm2/year and that of its perimeter 0.43 mm/year.

Conclusions: When stringent selection criteria were used to determine the extent of proximal aortic reconstruction, aortic root replacement and ascending aortic replacement for type A aortic dissection achieved comparable clinical outcomes.

Keywords: Aortic dissection; Aortic root replacement; Ascending aortic replacement; Bentall procedure; Supracoronary; Type A aortic dissection.

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Figures

Figure 1:
Figure 1:
All-cause mortality and cumulative incidence of proximal aortic reoperation after aortic root replacement and ascending aorta replacement after surgical treatment of Stanford type A aortic dissection.
Figure 2:
Figure 2:
Changes in aortic root diameter area and perimeter at preoperative, early postoperative and late postoperative imaging examinations in 102 patients. P-values are from the test of within-subjects effects.
None
See this image and copyright information in PMC

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