Evolution of Native Aortic Valve Function following Ascending Aorta Replacement for Acute Type A Dissection

Abstract

This study investigates the evolution of aortic valve function following supracoronary ascending aorta replacement (SCR) for acute type A aortic dissection (ATAAD). Factors contributing to aortic valve stability and progression of aortic valve insufficiency (AI) were examined.Patients who survived SCR for ATAAD between 2000 and 2021 were included. Univariable analyses to identify risk factors for AI grade ≥ 2 were performed, including anatomical parameters, perioperative findings, and follow-up root diameters. Evolution of aortic root dimensions was also investigated.Seventy-eight patients were included. AI grade ≥ 2 was observed in 20 (29.4%) patients during follow-up. Cumulative incidence of AI grade ≥ 2 was 4.7 ± 2.2%, 7.9 ± 3.4%, and 15.1 ± 5.5% at 1, 5, and 10 years, respectively. Aortic root reoperation was performed in three patients (4.0%) within 3 years of the index operation. Significant predictors of AI grade ≥ 2 included preoperative AI grade ≥2 (p = 0.037, odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.02-2.09) and significant preoperative AI grade ≥ 2 in presence of at least two dissected sinuses (p = 0.039, OR: 2.88, 95% CI: 1.05-7.89). Diameters of the sinus of Valsalva (p < 0.001), sinotubular junction (p < 0.001), and ascending aorta graft (p < 0.001) increased over time. Absence of sinus of Valsalva ≥ 45 mm was 90.9, 84.9, and 80.3% at 1, 5, and 10 years, respectively.Preserving the aortic valve after ATAAD offers a viable long-term surgical option with a low need for proximal root reoperations in patients without aortic root dilatation. Significant preoperative AI, particularly in presence of extensive root dissection, are significant predictors of late AI grade ≥ 2, suggesting valve-sparing root replacement in these patients.

Fig. 1

Patient selection flowchart. The blue colored box displays the study population.

Fig. 2

Kaplan–Meier survival curve of the study population. The number of patients at risk at a specific time point is indicated by a numeral above the corresponding year.

Fig. 3

Cumulative incidence of late AI grade ≥ 2, considering death as a competing risk. The number of patients at risk at a specific time point is indicated within the graph.

Fig. 4

Cumulative incidence of aortic root reoperation, considering death as a competing risk. The number of patients at risk at a specific time point is indicated within the graph.