Late echocardiographic study of aortic valve and aortic root after surgery for type a acute aortic dissection

Abstract

Objective:In case of concomitant aortic regurgitation (AR) valve, sparing operation is considered the first choice in selected patients. The aim of this retrospective clinical and echocardiographic study was to evaluate the long-term survival results of conservative approach and the determinants of recurrent AR.Methods:From 2000 to 2011, fifty patients (median: 63 years and interquartile range: 53–72) underwent an aortic valve-sparing procedure for acute aortic dissection, and discharged alive. The long-term clinical and echocardiographic outcome was analyzed.Results:Late all-causes mortality was 18% (nine patients) at a median follow-up of 55.8 months. Ten patients (20%) underwent re-operations, five of them for aortic valve/root recurrent disease; freedom from proximal re-operation was 90%. Two-third of the patients had a preoperative AR grade <3; a non-negligible number of patients with acute significant AR (23% with grade ≥3) at the time of surgery underwent conservative aortic valve surgery. At a median echocardiographic follow-up of 50.5 months, we found no significant correlation between late recurrent AR and AR grade at the time of surgery and the aortic root diameter. Late recurrent AR grade was significantly higher in patients who underwent aortic commissures and cusps resuspension than those who underwent lone ascending aorta replacement (2.29 ± 1.05 vs. 1.58 ± 1.03, P = 0.028).Conclusions:Preoperative AR and late aortic root diameter were not the predictors of late AR. Late AR is higher in patients who underwent aortic commissures and cusps resuspension compared to the only replacement of the ascending aorta.

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

“…that AR at presentation was not a predictor of subsequent reintervention of the aortic valve or AR in a retrospective case series. 14,15 In contrast Pesotto et al 16 did find that moderate or severe AR at presentation was associated with an increased risk of moderate or severe AR during follow-up in patients undergoing aortic valve resuspension.…”

“…Few studies have examined the performance of the native aortic valve following type A aortic dissection and in these there is a lack of consensus regarding the significance of AR at presentation. Molteni et al and Tang et al found that AR at presentation was not a predictor of subsequent reintervention of the aortic valve or AR in a retrospective case series 14,15 . In contrast Pesotto et al 16 did find that moderate or severe AR at presentation was associated with an increased risk of moderate or severe AR during follow‐up in patients undergoing aortic valve resuspension.…”