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CC BY 4.0 · Aorta (Stamford) 2016; 04(02): 33-41
DOI: 10.12945/j.aorta.2016.14.039
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection

Tyler M. Gunn
1   Department of Cardiothoracic Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
,
Sotiris C. Stamou
1   Department of Cardiothoracic Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
,
Nicholas T. Kouchoukos
2   Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, Missouri, USA
,
Kevin W. Lobdell
3   Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina, USA
,
Kamal Khabbaz
4   Division of Cardiothoracic Surgery, Department of Surgery and The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
,
Lawrence H. Patzelt
5   Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, Michigan, USA
,
Robert C. Hagberg
6   Department of Cardiac Surgery, Hartford Hospital, Hartford, Connecticut, USA
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Publikationsverlauf

28. Juni 2014

04. Februar 2016

Publikationsdatum:
24. September 2018 (online)

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Abstract

Background: The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure.

Methods: All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution’s Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed.

Results: The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035).

Conclusions: The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.

Key Words

Aorta - Aortic aneurysm - Aortic root - Aortic valve
 

  • References

  • 1 Bavaria JE, Brinster DR, Gorman RC, Woo YJ, Gleason T, Pochettino A. Advances in the treatment of acute Type A dissection: an integrated approach. Ann Thorac Surg 2002; 74: S1848-52 ; DOI: 10.1016/S0003-4975(02)04128-0
    CrossrefPubMedGoogle Scholar
  • 2 Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A. , et al. Predicting death in patients with acute Type a aortic dissection. Circulation 2002; 105: 200-206 . DOI: 10.1161/hc0202.102246
    CrossrefPubMedGoogle Scholar
  • 3 Stamou SC, Kouchoukos NT, Hagberg RC, Smith CR, Nussbaum M, Hooker RL. , et al. Differences in clinical characteristics, management, and outcomes of intraoperative versus spontaneous acute Type A aortic dissection. Ann Thorac Surg 2013; 95: 41-45 . DOI: 10.1016/j.athoracsur.2012.08.050
    CrossrefPubMedGoogle Scholar
  • 4 Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL. , et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283: 897-903 . DOI: 10.1001/jama.283.7.897
    CrossrefPubMedGoogle Scholar
  • 5 Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L. , et al. Epidemiology and clinicopathology of aortic dissection. Chest 2000; 117: 1271-1278 . DOI: 10.1378/chest.117.5.1271
    CrossrefPubMedGoogle Scholar
  • 6 Pacini D, Di Marco L, Fortuna D, Belotti LM, Gabbieri D, Zussa C. , et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol 2013; 167: 2806-2812 . DOI: 10.1016/j.ijcard.2012.07.008
    CrossrefPubMedGoogle Scholar
  • 7 Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation 2006; 114: 2611-2618 . DOI: 10.1161/CIRCULATIONAHA.106.630400
    CrossrefPubMedGoogle Scholar
  • 8 Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A. , et al. Diagnosis and management of aortic dissection. Eur Heart J 2001; 22: 1642-1681 . DOI: 10.1053/euhj.2001.2782
    CrossrefPubMedGoogle Scholar
  • 9 Krüger T, Conzelmann LO, Bonser RS, Borger MA, Czerny M, Wildhirt S. , et al. Acute aortic dissection Type A. Br J Surg 2012; 99: 1331-1344 . DOI: 10.1002/bjs.8840
    CrossrefPubMedGoogle Scholar
  • 10 Feldman M, Shah M, Elefteriades JA. Medical management of acute Type A aortic dissection. Ann Thorac Cardiovasc Surg 2009; 15: 286-293 . PMID: 19901881
    PubMedGoogle Scholar
  • 11 Krüger T, Weigang E, Hoffmann I, Blettner M, Aebert H. GERAADA Investigators. Cerebral protection during surgery for acute aortic dissection Type A: results of the German Registry for Acute Aortic Dissection Type A (GERAADA). Circulation 2011; 124: 434-443 . DOI: 10.1161/CIRCULATIONAHA.110.009282
    CrossrefPubMedGoogle Scholar
  • 12 Kouchoukos NT, Dougenis D. Surgery of the thoracic aorta. N Engl J Med 1997; 336: 1876-1888 . DOI: 10.1056/NEJM199706263362606
    CrossrefPubMedGoogle Scholar
  • 13 Klodell CT, Karimi A, Beaver TM, Hess PJ, Martin TD. Outcomes for acute Type A aortic dissection: effects of previous cardiac surgery. Ann Thorac Surg 2012; 93: 1206-1212 ; DOI: 10.1016/j.athoracsur.2011.12.076
    CrossrefPubMedGoogle Scholar
  • 14 Subramanian S, Leontyev S, Borger MA, Trommer C, Misfeld M, Mohr FW. Valve-sparing root reconstruction does not compromise survival in acute Type A aortic dissection. Ann Thorac Surg 2012; 94: 1230-1234 . DOI: 10.1016/j.athoracsur.2012.04.094
    CrossrefPubMedGoogle Scholar
  • 15 Lai DT, Miller DC, Mitchell RS, Oyer PE, Moore KA, Robbins RC. , et al. Acute Type A aortic dissection complicated by aortic regurgitation: composite valve graft versus separate valve graft versus conservative valve repair. J Thorac Cardiovasc Surg 2003; 126: 1978-1986 . DOI: 10.1016/S0022-5223(03)01279-0
    CrossrefPubMedGoogle Scholar
  • 16 Goda M, Imoto K, Suzuki S, Uchida K, Yanagi H, Yasuda S. , et al. Risk analysis for hospital mortality in patients with acute Type a aortic dissection. Ann Thorac Surg 2010; 90: 1246-1250 . DOI: 10.1016/j.athoracsur.2010.05.069
    CrossrefPubMedGoogle Scholar
  • 17 Kazui T, Washiyama N, Bashar AH, Terada H, Suzuki T, Ohkura K. , et al. Surgical outcome of acute Type A aortic dissection: analysis of risk factors. Ann Thorac Surg 2002; 74: 75-81 . DOI: 10.1016/S0003-4975(02)03603-2
    CrossrefPubMedGoogle Scholar
  • 18 Olsson C, Hillebrant CG, Liska J, Lockowandt U, Eriksson P, Franco-Cereceda A. Mortality in acute Type A aortic dissection: validation of the Penn classification. Ann Thorac Surg 2011; 92: 1376-1382 . DOI: 10.1016/j.athoracsur.2011.05.011
    CrossrefPubMedGoogle Scholar
  • 19 Sabik JF, Lytle BW, Blackstone EH, McCarthy PM, Loop FD, Cosgrove DM. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg 2000; 119: 946-962 . DOI: 10.1016/S0022-5223(00)70090-0
    CrossrefPubMedGoogle Scholar