Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up

Abstract

For acute type A aortic dissection, replacement of the ascending aorta with root preservation shows long-term effectiveness with low reoperation and aortic root dilatation rates.

Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection

“…Despite this more aggressive distal aortic surgical approach, in-hospital mortality was 12%, corresponding to the lower end of the range in published series. [10][11][12] Hemiarch replacement was associated with low reoperation rate for aortic arch aneurysm. Only 2 patients (0.4%) revealed an arch aneurysm and 5 (1%) developed pseudoaneurysm at the distal anastomosis in the cohort of 534 patients.…”

Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair

“…Despite vast improvements in diagnostic imaging and aortic surgery, the perioperative mortality rate for patients with acute type A dissection has remained at 8% to 34%. 6,7,9 We identified advanced age (>80 years), malperfusion of !1 organs, and total arch replacement as significant determinants of in-hospital mortality in patients with dissection extending beyond the ascending aorta. When stratified according to the initial aortic repair, the greatest mortality was observed in those with total arch replacement.…”

“…1 However, the surgical strategy for patients with the dissection process extending into the aortic arch but without an arch aneurysm or intimal tear within the arch remains controversial. Considering the still high perioperative mortality for patients with type A dissection of 8% to 34%, [5][6][7] the increased perioperative risk associated with more extensive distal aortic repair must be weighed against the risk of future reintervention and associated mortality.…”

Recurrent aortic dissection: a challenging but rare dilemma

“…While some groups have shown that the aortic root remains normal after acute Type A repair with root preservation, need for subsequent root replacement carried a 17% mortality risk. Furthermore, 11% of patients had root dilatation meeting criteria for replacement but were not operated on in that study, and patients with MFS were at higher risk for needing reoperation for root replacement if it was not intervened on at the time of initial Type A dissection (3).…”