Reinforced Aortic Root Reconstruction in Type A Aortic Dissection: A Prospective Study

Abstract

Background: Type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Many techniques have evolved to repair the dissected sinus segments and restore aortic valve dynamics. Herein, we evaluate the early outcome of a novel technique for reconstruction of dissected aortic root. Methods: A prospective study was conducted on 300 patients to evaluate the early results of repair of dissected root in type A aortic dissection. The mean age was 59.65±8.52 years, and 76% of patients were males. All patients had four standard steps for aortic reconstruction: 1) commissural resuspension; 2) right coronary sinus reinforcement with pericardial and Dacron bands; 3) non-coronary sinus reinforcement using external Dacron patch; 4) circumferential inversion of adventitial layer of the root. Patients were followed up clinically, echocardiographically, and by CT scan. Results: The in-hospital mortality was 8%. The mean cross-clamp time was 120±30 minutes, and circulatory arrest time was 25+10 minutes. Twenty-seven patients (9%) experienced postoperative complications, including bleeding and acute kidney injury. During a mean follow-up time of 48±12 months, there were no recurrent aortic dissection, aortic dilatation, pseudoaneurysm, or progression of aortic regurgitation during the entire study period. Conclusions: This reconstructive technique technically is undemanding, feasible, safe, and durable with good early results. A larger cohort of patients with longer period of follow up should generate a more powerful evaluation of this technique.

Early and midterm results of valve-sparing aortic root reconstruction with a bovine pericardium patch for patients with acute type a aortic dissection

“…Based on aforementioned pathophysiological mechanisms, we tried to preform valve-sparing aortic root reconstruction with a bovine pericardium patch for selected patients with ATAAD to reduce the complexity of the proximal procedure. Gelatin resorcin formalin glue, fibrinous glue, and Teflon felt strips were commonly used to repair the aortic root; however, the perioperative mortality rates of patients with ATAAD undergoing replacement of ascending aorta with aortic root preservation differ widely (6.6–34.0%) ( 8 – 10 , 12 ). The early mortality rate during our study was 4.2%, which is within the lower end of the published range.…”

“…This disease usually involves the aortic root and leads to aortic sinus dissection, aortic valve regurgitation, and coronary artery stenosis or occlusion ( 3 – 5 ). Several surgical strategies have been created to manage aortic root lesions with ATAAD, including aortic root replacement and aortic valve preservation with aortic root reconstruction ( 6 – 10 ).…”