BACKGROUND: The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures. METHODS: The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate. RESULTS: From March 1995 to April 2010, 208/374 patients (56%) undergoing AAAD repair received an aortic root procedure. Group 1 (n=130) underwent a Bentall operation, group 2 (n=51) underwent a modified Yacoub procedure, and group 3 (n=27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27%; group 2, 16%; group 3, 15%). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score=-0.279; p>0.05). Five-year survival estimates were 66% for group 1, 65% for group 2, and 80% for group 3 (log rank p=0.2). CONCLUSIONS: Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.
BACKGROUND: The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures. METHODS: The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate. RESULTS: From March 1995 to April 2010, 208/374 patients (56%) undergoing AAAD repair received an aortic root procedure. Group 1 (n=130) underwent a Bentall operation, group 2 (n=51) underwent a modified Yacoub procedure, and group 3 (n=27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27%; group 2, 16%; group 3, 15%). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score=-0.279; p>0.05). Five-year survival estimates were 66% for group 1, 65% for group 2, and 80% for group 3 (log rank p=0.2). CONCLUSIONS: Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.
Authors: Tyler M Gunn; Sotiris C Stamou; Nicholas T Kouchoukos; Kevin W Lobdell; Kamal Khabbaz; Lawrence H Patzelt; Robert C Hagberg Journal: Aorta (Stamford) Date: 2016-04-01
Authors: Manuel Caceres; Yicheng Ma; J Scott Rankin; Paramita Saha-Chaudhuri; Brian R Englum; James S Gammie; Rakesh M Suri; Vinod H Thourani; Fardad Esmailian; Lawrence S Czer; John D Puskas; Lars G Svensson Journal: Eur J Cardiothorac Surg Date: 2014-03-17 Impact factor: 4.191
Authors: Walter F DeNino; John Matthew Toole; Christopher Rowley; Martha R Stroud; John S Ikonomidis Journal: J Thorac Cardiovasc Surg Date: 2014-07-19 Impact factor: 5.209