Neomedia Repair of the Valsalva Sinus in the Treatment of Acute Type-A Aortic Dissection: Long-term Effectiveness and a Case of Pathology

Abstract

Although numerous surgical techniques are employed to treat acute Stanford type A aortic dissection (ATAAD), controversy remains over which is the best procedure for aortic root reconstruction. Among the various techniques utilized, neomedia repair is considered to be more promising than adhesive-only repair for the treatment of a dissected aortic root. We experienced a series of neomedia sinus Valsalva repair using woven polyester fabric, and evaluated the aortic root diameter by computed tomography and severity of aortic valve insufficiency by transthoracic echocardiography. The aortic root diameter was well preserved with no progress of aortic valve insufficiency in the long-term period. Furthermore, we found that the fabric looked functioning new media in the findings obtained from the pathological examination of a neomedia repaired aortic wall sample that was obtained by chance from a patient during valve replacement surgery performed 10 years after aortic reconstruction for ATAAD. Neomedia repair using woven polyester fabric for ATAAD might facilitate the long-term durability of the surgically treated aortic root. (This is a translation of J Jpn Coll Angiol 2019; 59: 37–43.)

Clinical outcomes of aortic root repair using pericardial autograft for acute type A aortic dissection

“…Our study showed that the severity of AI grade (group A: P < 0.001; group B: P < 0.001) and the enlargement of aortic root (group A: P < 0.001; group B: P = 0.005) were ameliorated in both groups after surgery [Figure S2 and S3], indicating both surgical techniques could improve the durability of aortic root and short-term effects, given AI and enlargement of proximal aorta could increase the risk of aortic root reoperation. [11] A multiple logistic regression analysis, considering these relevant confounding factors, indicated a signi cant correlation between the primary endpoint events and the surgical technique (OR, 0.002, 95%CI, 0-0.159; P = 0.026). This suggests that group A tended to have reduced 30-day mortality and a lower risk of reoperation for hemostasis.…”

Clinical outcomes of aortic root repair using pericardial autograft for acute type a aortic dissection

“…Although no significant differences were observed in 30-day mortality between the two groups ( P = 0.110), the 30-day mortality in group A was nil. Our study showed that the severity of AI grade (group A: P < 0.001; group B: P < 0.001) and the enlargement of aortic root (group A: P < 0.001; group B: P = 0.005) were ameliorated in both groups after surgery [Figure S3 and S4], indicating both surgical techniques could improve the durability of aortic root and short-term effects, given AI and enlargement of proximal aorta could increase the risk of aortic root reoperation [ 11 ].…”