Long-term results and postoperative aortic valve regurgitation outcome after repair of acute type A aortic dissection: A single-center study of 836 cases

Objectives: Aortic valve insufficiency is usually seen in patients with type A aortic dissection (AAD). This study examines the data on long-term outcome of aortic valve insufficiency (AI) in patients with acute type A aortic dissection. We retrospectively evaluated our data over a 15-year period starting in 1996.

Methods: Between 01/1996 and 11/2011 836 patients with mean age 59.6+−13.6 (range 18-96) underwent surgery for AAD. Ninety-two perioperative variables were statistically analyzed to identify predictors for outcome. Preoperative, postoperative and follow-up echocardiography was considered a parameter for AI severity. The long-term outcome of AI considered the exact date of the follow-up echocardiography, the need for reoperation on the aortic valve, and the surgical technique used.

Results: Of the entire cohort 372 patients (45%) had preoperative AI grade II or more, of which 189 patients (51%) underwent aortic valve replacement (162 with Conduit), and 183 (49%) aortic root reconstruction. Of these, 4 patients had postoperative grade II, 38 low grade and 330 (88%) had no AI. At follow-up echocardiography (mean 2.6 yrs.) 35 patients had AI grade II or more, 46 low grade and 291 (78%) no AI. Of these, 29 patients (8%) were reoperated (22 with aortic root reconstruction), 6 patients due to isolated AI and the rest because of re-dissection, endocarditis, paravalvular leak, thrombosis and prosthesis perforation. 311 patients (37%) had preoperative low grade AI, of which 203 patients (65%) underwent surgery with aortic root reconstruction, 31 patients (10%) with aortic valve replacement (20 with Conduit). Of these, postoperatively 1 patient had AI grade II, 56 low grade and 254 (82%) had no aortic regurgitation. At follow-up echocardiography (mean 2.1 yrs.) 26 patients had AI grade II or more, 72 low grade and 213 (69%) no AI. Of this group 18 patients (6%) were reoperated (13 with aortic root reconstruction), 2 patients because of isolated AI and the rest because of re-dissection and endocarditis. Preoperatively, 154 patients (18%) had no AI, there was only one patient with AI grade III at follow-up who underwent a reoperation because of re-dissection.

Conclusions: Although postoperative echocardiography after aortic root reconstruction on acute type A aortic dissection patients shows satisfactory results, the choice of surgical treatment has a considerable impact on long-term aortic valve insufficiency outcome.