Aortic Root Reconstruction With Pledgeted Sutures in Patients With Acute Type A Aortic Dissection

Abstract

Background: The aortic root is invariably dissected in patients with acute type A aortic dissection (ATAD). We have used an aortic root reconstruction technique using pledgeted sutures to reattach the dissected wall without surgical glue. We reviewed our 2-decade experience to evaluate the results of aortic root reconstruction with pledgeted sutures in ATAD.

Methods: All open ATAD repairs from our institution from January 1999 to December 2024 were reviewed, and early and late outcomes of supracoronary aortic repair with aortic root reconstruction were evaluated. Outcomes of adverse aortic root events were defined by aortic-related death, proximal aortic reoperation, aortic root dilation (>55 mm), severe aortic insufficiency, endocarditis, or graft infection.

Results: Type A aortic repair was performed in 841 patients. After 83 patients (9.9%) who underwent aortic root replacement were excluded, 758 (90.1%) who received aortic root reconstruction were included. The preoperative mean aortic root diameter was 41.8 (SD, 6.2) mm, with organ malperfusion developing in 294 (38.8%), including 44 (5.8%) with coronary malperfusion. Total arch replacement was performed in 76 (10.0%) and aortic valve replacement in 21 (2.8%). Operative mortality was 14.1% (n = 107). Overall survival was 72.2% at 5 years and 56.5% at 10 years. Freedom from proximal reoperation was 96.0% at 5 years and 88.4% at 10 years. Freedom from adverse aortic root events was 93.2% at 5 years and 81.1% at 10 years.

Conclusions: Aortic root reconstruction with pledgeted sutures may be performed with reasonable early and late outcomes for ATAD, including patients with a moderately dilated aortic root.