A novel technique to rebuild the Valsava sinus in acute type A aortic dissection

Background. There has been many techniques described to preserve the integrity of the aortic root with good outcomes for those with acute type A aortic dissection. However, whether to use these technique in emergency patients presenting with AADA remains controversial.Methods. Between December 2019 and Feburary 2021, 11 patients underwent aortic root partial repair using a button technique.Results. The postoperative echocardiography 1 month after operation showed mild regurgitation in 7 cases and moderate regurgitation in 2 cases. Two patients died because of low cardiac outflow. Temporary neurological dysfunction was observed in one patient and hoarseness occurred in one patient.Conclusions. Our partial aortic root remodeling operation is very easy to operate and has a good short-term effect. It might be a useful strategy for acute type A aortic dissection in patients with one or two Valsalva sinuses affected.

Aortic Root Remodeling in Acute Aortic Dissection

Objectives To evaluate the long-term results of remodeling in acute aortic dissection type A (AADA) to define operative risk and root and valve stability. Methods Between October 1995 and December 2018, a total of 352 patients were treated surgically for AADA. Of these, 90 patients with AADA (<2 weeks from onset; age: 57 ± 15 years; 70 males) with a root diameter of >43 to 45 mm (depending on patient size) (48 ± 4.1 mm) underwent aortic root remodeling and were analyzed further. As the control group, we chose the patients with normally sized aortic roots who had been treated by tubular replacement only (n = 227). Other procedures were performed in 35 cases. Results Early mortality was 9% in the remodeling group versus 15% in the tubular ascending aortic replacement (TAR). Actuarial survival at 10 and 15 years was 68 ± 5% and 58.3 ± 6.4%, respectively, in the root remodeling group versus 68 ± 4% and 66 ± 4% in the TAR group (p = 0.99). Freedom from reoperation on the aortic valve or root was 95 ± 3% at 10 years and at 89 ± 6% at 15 years. Freedom from proximal reoperation after TAR at 10 and 15 years was 93 ± 3% and 91 ± 3% (n = 31 patients at risk), respectively, not statistically different from that after remodeling (p = 0.75). Conclusions The long-term stability of aortic root remodeling for enlarged roots with AADA was comparable to TAR preserving a normal aortic root.