Radical replacement of the aortic root in acute type A dissection: indications and outcome

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Abstract
OBJECTIVE: Failure of the repair at the proximal aorta is an importantcause of morbidity and mortality following surgical treatment of acute typeA dissection. This review was undertaken to determine the influence oftotal composite replacement of the ascending aorta and the root on theoperative risk and long-term survival. METHODS: In a consecutive series of73 patients with acute type A dissections between 1985 and 1994, 19 (26%)patients with radical root replacement (group I) were compared with 54patients who had conventional valve-preserving root reconstruction (groupII). RESULTS: Group I represented a higher operative risk with the presenceof significant aortic regurgitation (13/19 68.4% vs 23/54 42.5% P <0.05), aortic dilatation (19/19 100% vs 32/54 59.2% P < 0.00), andcoronary dissection (13/19 68.4% vs 3/54 5.5% P < 0.000). In spite ofthis there was no difference in operative mortality (3/19 15.7% vs 7/5412.9%, NS) or the occurrence of major postoperative complications: bleeding(3/19 15.7% vs 7/54 12.9%, NS), respiratory (5/19 26.3% vs 11/54 20.3%,NS), stroke (2/19 10.5% vs 3/54 5.5%, NS). Patients with radical rootreplacement had substantially better event-free survival at 5 years (87.5%+/- 11.7% vs 67.1% +/- 8.9%) and 9 years (87.5% +/- 21.9% vs 63.0% +/-19.2%). CONCLUSIONS: This experience confirms that, in the treatment ofacute type A dissection, an aggressive approach to aortic root pathology isindicated for specific indications, and can be carried out with good earlyand excellent long-term results.

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