BACKGROUND: The aim of this study was to evaluate the fate of the preserved aortic root after supracoronary aortic replacement for acute type A aortic dissection. METHODS: Between October 1999 and March 2018, 339 patients underwent supracoronary aortic replacement for acute type A aortic dissection at our institution. Late outcomes were evaluated, including overall survival, aortic-related death, and aortic root-related reoperation. The median follow-up was 3.7 years (1.4-8.4 years). RESULTS: Operative mortality was 46 patients (13.6%). The cumulative incidences at 5 years for aortic root-related reoperation, aortic-related death, and non-aortic related death were 2.5%, 14.5% and 12.4%, respectively. Multivariable Cox hazard regression analysis demonstrated greater sinus of Valsalva diameter and number of commissural detachments to be significant risk factors for a composite outcome consisting of aortic-related death or aortic root-related reoperation. Mixed-effects regression demonstrated that sinus of Valsalva diameter significantly increased with time (P < .001), and aortic regurgitation significantly worsened (P < .001). CONCLUSIONS: Sinus of Valsalva diameter and commissural detachment were independent predictors of unfavorable outcomes after supracoronary aortic replacement. Close follow-up is particularly necessary for these patients, and aortic root replacement at the time of initial operation may lead to more favorable late outcomes.
BACKGROUND: The aim of this study was to evaluate the fate of the preserved aortic root after supracoronary aortic replacement for acute type A aortic dissection. METHODS: Between October 1999 and March 2018, 339 patients underwent supracoronary aortic replacement for acute type A aortic dissection at our institution. Late outcomes were evaluated, including overall survival, aortic-related death, and aortic root-related reoperation. The median follow-up was 3.7 years (1.4-8.4 years). RESULTS: Operative mortality was 46 patients (13.6%). The cumulative incidences at 5 years for aortic root-related reoperation, aortic-related death, and non-aortic related death were 2.5%, 14.5% and 12.4%, respectively. Multivariable Cox hazard regression analysis demonstrated greater sinus of Valsalva diameter and number of commissural detachments to be significant risk factors for a composite outcome consisting of aortic-related death or aortic root-related reoperation. Mixed-effects regression demonstrated that sinus of Valsalva diameter significantly increased with time (P < .001), and aortic regurgitation significantly worsened (P < .001). CONCLUSIONS: Sinus of Valsalva diameter and commissural detachment were independent predictors of unfavorable outcomes after supracoronary aortic replacement. Close follow-up is particularly necessary for these patients, and aortic root replacement at the time of initial operation may lead to more favorable late outcomes.
Authors: Mikko Jormalainen; Risto Kesävuori; Peter Raivio; Antti Vento; Caius Mustonen; Hannu-Pekka Honkanen; Stefano Rosato; Jarmo Simpanen; Kari Teittinen; Fausto Biancari; Tatu Juvonen Journal: Interact Cardiovasc Thorac Surg Date: 2022-02-21
Authors: Fausto Biancari; Giovanni Mariscalco; Hakeem Yusuff; Geoffrey Tsang; Suvitesh Luthra; Francesco Onorati; Alessandra Francica; Cecilia Rossetti; Andrea Perrotti; Sidney Chocron; Antonio Fiore; Thierry Folliguet; Matteo Pettinari; Angelo M Dell'Aquila; Till Demal; Lenard Conradi; Christian Detter; Marek Pol; Peter Ivak; Filip Schlosser; Stefano Forlani; Govind Chetty; Amer Harky; Manoj Kuduvalli; Mark Field; Igor Vendramin; Ugolino Livi; Mauro Rinaldi; Luisa Ferrante; Christian Etz; Thilo Noack; Stefano Mastrobuoni; Laurent De Kerchove; Mikko Jormalainen; Steven Laga; Bart Meuris; Marc Schepens; Zein El Dean; Antti Vento; Peter Raivio; Michael Borger; Tatu Juvonen Journal: J Cardiothorac Surg Date: 2021-06-10 Impact factor: 1.637