Aortic root replacement to treat type A aortic dissection: A comparison of midterm outcomes between composite valve grafts and porcine aortic roots

Salmasi, Mohammad Yousuf; Panda, Abinash; Hartley, Philip; Abdulkhader, Ashiq; Osman, Ahmed; Nienaber, Christoph; Athanasiou, Thanos; Asimakopoulos, George

doi:10.1111/jocs.14712

Cited by 2 publications

(3 citation statements)

References 25 publications

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“…Within the Bentall's subgroup 23 patients had a mechanical composite valve-graft and 4 patients had a tissue valve-graft. These different composite valve-grafts (ARR) have been shown to have comparable mid-term outcomes following ATAAD and are therefore considered as a single group for the purposes of analysis [9].…”

Section: Resultsmentioning

confidence: 99%

Comparison of outcomes between aortic root replacement and supra-coronary interposition graft for type A aortic dissection: A Retrospective Case Series

Hartley

Salmasi

Morosin

et al. 2022

Preprint

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Background The decision to conserve or replace the native aortic valve following acute type-A aortic dissection (ATAAD) is an area of cardiac surgery without standardised practice. This single centre retrospective study analysed the long-term performance of the native aortic valve and root following surgery for ATAAD. Methods Between 2009 and 2018 all cases ATAAD treated at Royal Brompton and Harefield NHS Foundation Trust were analysed. Patients were divided into 2 groups: a) ascending aorta (interposition) graft (AAG) without valve replacement; and b) non-valve-sparing aortic root replacement (ARR). Pre-operative covariates were compared, as well as operative characteristics and post-operative complications. Long-term survival and echocardiographic outcomes were analysed using regression analysis. Results In total, 116 patients were included: 63 patients in the AAG group and 53 patients in the ARR group. In patients where the native aortic valve was conserved, 9 developed severe aortic regurgitation and 2 patients developed dilation of the aortic root requiring subsequent replacement during the follow-up period. Aortic regurgitation at presentation was not found to be associated with subsequent risk of developing severe aortic regurgitation or reintervention on the aortic valve. Overall mortality was observed to be significantly lower in patients undergoing AAG (17.5% vs. 41.5%, p=0.004). Conclusions With careful patient selection, the native aortic root shows good long-term durability both in terms of valve competence and stable root dimensions after surgery for ATAAD. This study supports the consideration of conservation of the aortic valve during emergency surgery for type-A dissection, in the absence of a definitive indication for root replacement, including in cases where aortic regurgitation complicates the presentation.

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Section: Resultsmentioning

confidence: 99%

Comparison of outcomes between aortic root replacement and supra-coronary interposition graft for type A aortic dissection: A Retrospective Case Series

Hartley

Salmasi

Morosin

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…These different composite valve-grafts (ARR) have been shown to have comparable midterm outcomes following ATAAD and are therefore considered as a single group for the purposes of analysis. 8 Table 1 compares the patient baseline demographics of the AAG and ARR cohorts. There were no significant differences between the two cohorts with respect to age, gender, co-morbidities, and BMI.…”

Section: Resultsmentioning

confidence: 99%

“…Within Bentall's subgroup 23 patients had a mechanical composite valve graft and four patients had a tissue valve graft. These different composite valve‐grafts (ARR) have been shown to have comparable midterm outcomes following ATAAD and are therefore considered as a single group for the purposes of analysis 8 …”

Section: Resultsmentioning

confidence: 99%

Comparison of outcomes between aortic root replacement and supra‐coronary interposition graft for type A aortic dissection: A retrospective case series

Hartley

Salmasi

Morosin

et al. 2022

Journal of Cardiac Surgery

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Background The decision to conserve or replace the native aortic valve following acute type‐A aortic dissection (ATAAD) is an area of cardiac surgery without standardized practice. This single‐center retrospective study analysed the long‐term performance of the native aortic valve and root following surgery for ATAAD. Methods Between 2009 and 2018 all cases ATAAD treated at Royal Brompton and Harefield NHS Foundation Trust were analysed. Patients were divided into two groups: (a) ascending aorta (interposition) graft (AAG) without valve replacement and (b) nonvalve‐sparing aortic root replacement (ARR). Preoperative covariates were compared, as well as operative characteristics and postoperative complications. Long‐term survival and echocardiographic outcomes were analysed using regression analysis. Results In total, 116 patients were included: 63 patients in the AAG group and 53 patients in the ARR group. In patients where the native aortic valve was conserved, nine developed severe aortic regurgitation and two patients developed dilation of the aortic root requiring subsequent replacement during the follow‐up period. Aortic regurgitation at presentation was not found to be associated with subsequent risk of developing severe aortic regurgitation or reintervention on the aortic valve. Overall mortality was observed to be significantly lower in patients undergoing AAG (17.5% vs. 41.5%, p = .004). Conclusions With careful patient selection, the native aortic root shows good long‐term durability both in terms of valve competence and stable root dimensions after surgery for ATAAD. This study supports the consideration of conservation of the aortic valve during emergency surgery for type‐A dissection, in the absence of a definitive indication for root replacement, including in cases where aortic regurgitation complicates the presentation.

show abstract

Aortic root replacement to treat type A aortic dissection: A comparison of midterm outcomes between composite valve grafts and porcine aortic roots

Cited by 2 publications

References 25 publications

Comparison of outcomes between aortic root replacement and supra-coronary interposition graft for type A aortic dissection: A Retrospective Case Series

Comparison of outcomes between aortic root replacement and supra-coronary interposition graft for type A aortic dissection: A Retrospective Case Series

Comparison of outcomes between aortic root replacement and supra‐coronary interposition graft for type A aortic dissection: A retrospective case series

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