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Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection.

Authors
  • Bojko, Markian M1
  • Assi, Roland2
  • Bavaria, Joseph E2
  • Suhail, Maham3
  • Habertheuer, Andreas2
  • Hu, Robert W2
  • Harmon, Joey2
  • Milewski, Rita K2
  • Desai, Nimesh D2
  • Szeto, Wilson Y2
  • Vallabhajosyula, Prashanth4
  • 1 College of Medicine, Drexel University, Philadelphia, Pa.
  • 2 Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • 3 Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY.
  • 4 Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn. Electronic address: [email protected]
Type
Published Article
Journal
The Journal of thoracic and cardiovascular surgery
Publication Date
May 04, 2020
Identifiers
DOI: 10.1016/j.jtcvs.2020.04.064
PMID: 32620395
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The durability of root repair for acute type A aortic dissection is not well studied in the context of aortic insufficiency and stability of the sinuses of Valsalva. We compared clinical and functional outcomes in patients undergoing root repair and replacement for acute type A aortic dissection. Of 716 patients undergoing surgery for acute type A aortic dissection, 585 (81.7%) underwent root repair and 131 (18.3%) underwent root replacement. Survival, cumulative incidence of reoperation, aortic insufficiency, and sinuses of Valsalva dilation were compared between the 2 groups. Survival at 1, 5, and 10 years was 84.1% versus 77.3%, 70.8% versus 69.2%, 57.6% versus 58.0% in the root repair and replacement groups, respectively (P = .69). Cumulative incidence of reoperation at 1, 5, and 10 years was 0.0% versus 0.8%, 1.4% versus 3.8%, and 3.4% versus 8.6% in the root repair and root replacement groups, respectively (P = .011). Multivariable Cox regression identified sinuses of Valsalva diameter 45 mm or more as a risk factor for proximal aortic reoperation (hazard ratio, 9.06; 95% confidence interval, 1.26-65.24). In a repeated-measures, linear, mixed-effects model, root replacement was associated with smaller follow-up of sinuses of Valsalva dimensions (β = -0.66, P < .001). In an ordinal longitudinal mixed model, root replacement was associated with lower severity of postoperative aortic insufficiency (β = -3.10, P < .001). Survival is similar, but the incidence of aortic insufficiency and root dilation may be greater after root repair compared with root replacement for acute type A aortic dissection. Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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