Aortic root conservative repair of acute type A aortic dissection involving the aortic root: Fate of the aortic root and aortic valve function

Ro, Sun Kyun; Kim, Joon Bum; Hwang, Sung‐Wook; Jung, Sung Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

doi:10.1016/j.jtcvs.2012.08.055

Cited by 43 publications

(42 citation statements)

References 17 publications

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“…Contemporary reports showed 10% to 25% perioperative mortality in spite of advances in techniques and perioperative management (3)(4)(5)12). These numbers increase dramatically when there is hemodynamic compromise at presentation (1,2,(5)(6)11,13,14). Hence, early recognition and surgical correction is recommended to prevent aortic rupture, repair the aortic regurgitation, and restore flow to end-organs (2,14).…”

Section: Discussionmentioning

confidence: 99%

“…Conservative root repair has been recommended to reduce the complexity of the surgery, with the goal of improving the initial operative outcome rather than long-term sequelae (1,3,(7)(8)10,25,26). Aortic valve re-suspension has been utilized to repair the AR with good results, as long as the root is not excessively dilated or the intimal tear does not extend below the sino-tubular junction (1,7,26).…”

Section: Root Management and Extent Of Distal Repairmentioning

confidence: 99%

“…Aortic valve re-suspension has been utilized to repair the AR with good results, as long as the root is not excessively dilated or the intimal tear does not extend below the sino-tubular junction (1,7,26). In contrast, others have proposed a more extensive aortic root replacement during the initial surgery, since leaving diseased tissue in situ poses a risk of aortic dilatation and pseudoaneurysm formation in as many as 9% to 27% of TAAD (1,3,21).…”

Section: Root Management and Extent Of Distal Repairmentioning

confidence: 99%

“…Ascending aortic dissection remains one of the most catastrophic emergencies amongst cardiovascular diseases (1)(2)(3)(4)(5). Delay in diagnosis and surgical treatment is associated with increased mortality (2,6).…”

Section: Introductionmentioning

confidence: 99%

“…Despite diminishing reliance on the femoral artery, there has been no consensus on the best arterial cannulation technique with the lowest complication rate that could shorten operative times (9). Proponents of a more conservative root management and extent of distal repair claimed that early survival is improved by reducing the complexity of the surgery, a gain that is offset by the higher risk of reoperation when diseased aortic tissue is left in situ (1,7,8,10).…”

Section: Introductionmentioning

confidence: 99%

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Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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Background: Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated-such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes.Methods: All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method.Results: Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support postoperatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study.Conclusion: TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the short and long term.

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