Dilated sinuses of Valsalva subsequent to type A dissection surgery: Is reoperation inevitable?

Abstract

Background: This study aims to investigate the dilation of sinus valsalva in patients who underwent aortic repair due to type A aortic dissection and to evaluate its progression. Methods: Between January 2004 and December 2019, a total of 68 patients (50 males, 18 females; mean age: 54.2±10.1 years; range, 30 to 82 years) who underwent root-preserving surgery and followed for at least one year in the outpatient setting were retrospectively analyzed. The patients were divided into two groups according to dilatation during follow-up. Group 1 (n=32) included patients with dilatation and Group 2 (n=36) included patients without dilatation. The sinus of Valsalva diameters were measured using pre- and postoperative computed tomography angiography. Results: The mean follow-up was 4.9±3.1 (range, 1 to 4) years. Sinus of Valsalva dilatation was observed in 47% of the patients during follow-up. Preoperative sinus of Valsalva diameter was a risk factor for aneurysmatic dilatation. A diameter of ≥4.05 cm was calculated as a cut-off value for developing dilatation requiring reoperation. Conclusion: Follow-up using postoperative echocardiography or computed tomography angiography is of utmost importance for the assessment of development of sinus of Valsalva dilatation which requires reoperation in patients without intervention to the aortic root.

Aortic root management in acute type a dissection surgery

“…In their retrospective study regarding aortic root management, Kose et al[ 1 ] studied 68 patients with a mean age of 54.2±10.1 years for an average of 4.9±3.1 years following a root protective surgery (supracoronary graft interposition without commissural resuspension). Of 64 patients, 32 (47.06%) had sinus of Valsalva (SOV) dilatation (SOV diameter: 5.23±0.61 cm), while 36 (52.94%) had normal SOV (SOV diameter: 3.74±0.43 cm).…”

“…In these studies, the diameter of the aortic root above ≥4.5 cm was one of the indications of the root replacement. [ 6 ] The reason that Kose et al's[ 1 ] study found a preoperative SOV diameter of ≥4.05 cm as a reoperation risk factor could be not resuspending the commissures and having a younger patient population in the study. In my professional opinion, further studies are necessary to correlate the preoperative SOV diameter and reoperation risk.…”