The fate of aortic root and aortic regurgitation after supracoronary ascending aortic replacement for acute type A aortic dissection

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.

Automated summary

The study evaluated the fate of preserved aortic root after supracoronary aortic replacement for acute type A aortic dissection. It found that sinus of Valsalva diameter and commissural detachment were independent predictors of unfavorable outcomes. Close follow-up is necessary for these patients, and aortic root replacement at the time of initial operation may lead to more favorable late outcomes.