Long-term outcomes after valve-sparing anatomical aortic root reconstruction in acute dissection involving the root

Aortic valve repair in type A aortic dissection

“…Table 1 summarizes retrospective studies that analyzed aortic valve repair and root sparing operations in type A aortic dissection. We selected 10 studies from 2010 to 2019 with a number of patients ranging from 24 to 307 from single centers experiences (7,9,(18)(19)(20)(21)(22)(23)(24)(25). Patient population was young, ranging from 49 years of Tanaka et al (9) at Kobe University to the oldest 62±14 mean age of Yacoub population in the Leipzig experience (19).…”

Commentary: Can partial sinus replacement replace standard valve-sparing replacement?

“…In this issue of the Journal, Irimie and colleagues 1 report their single-center experience of 100 consecutive patients presenting with acute type A aortic dissection who received operation with an aortic root remodeling technique (selected sinus replacement [SSR]) between 2001 and 2018. Depending on the intraoperative observation of dissected sinus, the patients underwent replacement of 1 (n ¼ 62), 2 (n ¼ 32), or 3 (n ¼ 6) aortic sinuses.…”

“…2,3 Irimie and colleagues 1 are to be congratulated for demonstrating excellent long-term outcomes of their expeditious surgical strategy to treat acute type A aortic dissection, in which the decision to undertake this technique has been uniformly maintained throughout their 19-year experience. As described by Irimie and colleagues, 1 the SSR technique was used in 100 of 170 patients presenting with root-involving acute aortic dissection during the study period, including 77% of the patients operated on by a single expert surgeon. Accordingly, the favorable surgical outcomes in this study may also be attributable to patient selection and the surgical expertise.…”

“…As addressed by Irimie and colleagues, 1 proper sizing of the aortic graft during SSR in the setting of acute type A aortic dissection is challenging. To raise the same issue in valve-sparing root reimplantation, they gave an example of severe downsizing of the aortic annulus resulting in AI, which is probably not a good example for experts who deal with such procedures.…”

Commentary: Aortic root reconstruction in acute dissection: What is the reality?

“…Until the achievement of such knowledge has been realized, the realistic surgical approach to such dissected root pathology may well be to apply the ''gold standard'' of Bental's root replacement as suggested by Irimie and colleagues. 1…”