Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up

Abstract OBJECTIVES We evaluated the long-term results of aortic root (AR) preservation and replacement in patients operated on for acute type A aortic dissection. METHODS Out of 302 patients discharged after repair of acute aortic dissection (1977–2019), 124 patients had an AR ≥40 mm, which was preserved in 84 (68%, group A) patients and replaced in 40 (32%, group B) patients. Group B patients were younger (mean age 57 ± 12 vs 62 ± 11 years, P = 0.07), with a mean AR of 47 vs 43 mm and ≥moderate aortic insufficiency in 65% vs 30%. Survival, causes of death and reoperations were analysed at mean follow-up of 9 ± 8 years (6 months to 40 years). RESULTS Actuarial survival of discharged patients at 5, 10 and 15 years was 97% (0.89–0.99), 78% (0.67–0.90) and 75% (0.64–0.88) in group A, and 85% (0.71–0.95), 62% (0.44–0.78) and 57% (0.39–0.76) in group B (log-rank test P = 0.2). Nine patients in group A (7 patients for aortic insufficiency and dilatation of the root and 2 patients for pseudoaneurysm) and 1 patient of group B (pseudoaneurysm of the right coronary button) required proximal reoperation without deaths. At 5, 10 and 15 years, the cumulative incidence of proximal aortic reoperations was 5%, 9% and 25% in group A, and 0%, 3% and 3% in group B (P = 0.02). At multivariable analysis AR >45 mm [hazard ratio (HR) 6.8, P = 0.026] and age (HR 0.9, P = 0.016) were independently associated with proximal reoperation. CONCLUSIONS AR preservation in acute type A dissection showed acceptable long-term outcomes. Nevertheless, a more aggressive approach appears a valid option, especially in patients with AR diameter >45 mm.

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Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

10.22541/au.163256960.06606439/v1 ◽

2021 ◽

Author(s):

Mahmoud Alhussaini ◽

Eric Jeng ◽

Tomas Martin ◽

Amber Filion ◽

Thomas Beaver ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection ◽

Valve Sparing

Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

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Faculty Opinions recommendation of Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739273857.793581623 ◽

2021 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Acute Aortic Dissection ◽

Type A ◽

Long Term Follow Up

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Preservation of the Aortic Root During Type A Aortic Dissection Surgery: An Effective Strategy?

Aorta ◽

10.1055/s-0041-1725074 ◽

2021 ◽

Author(s):

Christophe Baufreton ◽

Olivier Fouquet ◽

Simon Dang Van ◽

Jihed Laribi ◽

Frédéric Pinaud ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Regurgitation ◽

Aortic Root ◽

False Lumen ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Long Term Follow Up

Abstract Background Management of the aortic root during acute Type A aortic dissection (TAAD) repair remains controversial in term of long-term evolution and reoperation. The aim of this study was to assess the long-term outcomes of the aortic root after conservative management during primary surgery. Methods One hundred sixty-four consecutive patients were included in this monocentric retrospective study. The primary endpoint was reoperation on the aortic root during long-term follow-up. Forty-six patients had aortic root replacement (ARR) and 118 had supracoronary aortic replacement (SCR). The 10-year survival, occurrence of significant aortic regurgitation, and radiologic aortic root dilatation in each group were assessed during follow-up. Results Patients from ARR group were younger than those from SCR group (p < 0.0001). Median follow-ups of ARR group and SCR group are 4.4 (interquartile range [IR]: 2.6–8.3) and 6.15 (IR: 2.8–10.53) years, respectively. Reoperation of the aortic root during long-term follow-up was similar in both groups (ARR group: 5.1%, SCR group: 3.3%, p = 0.636). The 10-year survivals of ARR and SCR groups were 64.8 ± 12.3% and 46.3 ± 5.8% (p = 0.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups (p = 0.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies (p = 0.58). Reoperation on the distal aorta (p = 0.012) and patent radiologic false lumen of the descending aorta (p = 0.043) were independent risk factors of late death. Conclusion SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root.

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Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.09.049 ◽

2013 ◽

Vol 146 (6) ◽

pp. 1456-1460 ◽

Cited By ~ 19

Author(s):

Angelo M. Dell'Aquila ◽

Giovanni Concistrè ◽

Alina Gallo ◽

Stefano Pansini ◽

Alessandro Piccardo ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Traumatic aortic root rupture leading to acute aortic insufficiency and acute Type A aortic dissection.

10.22541/au.161047978.85180965/v1 ◽

2021 ◽

Author(s):

Subash Nepal ◽

Vijay Raj ◽

Debanik Chaudhuri ◽

Stephany Barreto

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Aortic Insufficiency ◽

Pulmonary Contusion ◽

Acute Type ◽

Multiple Fractures ◽

Type A Aortic Dissection ◽

Cardiac Symptoms ◽

Ct Angiogram

A 17-year-old male was admitted for the management of multiple fractures after sustaining blunt thoracic trauma. He was hemodynamically stable and without any cardiac symptoms. He was admitted with fracture of T4 end plate, manubrium and left first rib, right pulmonary contusion, left apical pneumothorax and pneumomediastinum. The patient underwent echocardiography and cardiac CT angiogram for the work up of aortic injury as the patient had new aortic regurgitation murmur, troponin rise and RBBB. He was found to have aortic root rupture, type A aortic dissection and acute severe aortic insufficiency. The patient underwent surgical aortic valve and root replacement with Bentall procedure with good outcome.

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Early Spontaneous Resolution of an Iatrogenic Acute Type A Aortic Dissection

Aorta ◽

10.12945/j.aorta.2016.16.067 ◽

2016 ◽

Vol 04 (06) ◽

pp. 235-239

Author(s):

Mohammad Zafar ◽

Philip Pang ◽

Glen Henry ◽

Bulat Ziganshin ◽

Maryann Tranquilli ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type I ◽

Acute Type ◽

Computed Tomography Scan ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Tomography Scan

AbstractAcute aortic dissection is a rare but devastating complication during cardiac catheterization. We present the case of an elderly female who incurred a Stanford Type A/DeBakey Type I acute aortic dissection extending into the arch vessels and descending aorta likely occurring during right coronary artery engagement for angioplasty. The patient was treated successfully by immediately sealing the entrance of the dissection via the placement of a stent and anti-impulse therapy. Follow-up computed tomography scan showed complete resolution of the dissection within one month.

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A case report of aortic root repair using a pericardial autograft for type A aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01356-z ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yi Chang ◽

Hongwei Guo ◽

Xiangyang Qian ◽

Fang Fang

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Aortic Wall ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Intimal Flap ◽

Root Repair ◽

Coronary Ostia

Abstract Background Acute type A aortic dissection with a dissection flap extending into the sinus segment often involves the commissures and the coronary ostia. In most cases, the intimal flap must be retained in order to restore aortic valve competence and reconstruct the coronary ostia. Residual dissection flap has the potential risks of proximal bleeding and adverse effects on long-term durability. We established a novel technique to reconstruct the aortic root using a pericardial autograft and significantly reduce remnant dissection tissues. Case presentation A 50-year-old female was admitted to our center with acute anterior chest pain and backache lasting about 10 h. Computed tomographic (CT) scans showed type A aortic dissection, with both coronary ostia being involved. Doppler echocardiography showed moderate aortic insufficiency. The dissection intimal flap was removed to the normal aorta wall near the annulus at the noncoronary sinus, leaving a 5 mm rim of intimal flap near the commissures and coronary ostia. Using a pericardial patch as a new aortic wall to reconstruct the root while preserving the aortic adventitia to fix and strengthen the new pericardial aortic wall. Ascending aorta and total arch replacement combined with frozen elephant trunk procedure was performed at the same time. The patient got an uneventful postoperative course. Conclusion Aortic root repair with a pericardial autograft is a safe and effective technique to treat acute type A dissection involving the sinus. Using this technique, residual dissection tissues could be significantly reduced, which subsequently decreases the risk of proximal bleeding and hence increases long-term durability.

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