Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience

Abstract

Objective: The study objective was to evaluate the perioperative and long-term outcomes of aortic root repair and aortic root replacement and provide evidence for root management in acute type A aortic dissection.Methods: From 1996 to 2017, 491 patients underwent aortic root repair (n ¼ 307) or aortic root replacement (n ¼ 184) (62% bioprosthesis) for acute type A aortic dissection. Indications for aortic root replacement were intimal tear at the aortic root, root measuring 4.5 cm or more, connective tissue disease, or unrepairable aortic valvulopathy. Primary outcomes were in-hospital mortality, long-term survival, and reoperation rate for root pathology.Results: Patients' median age was 61 years and 56 years in the aortic root repair group and aortic root replacement group, respectively. The aortic root replacement group had more renal failure requiring dialysis, previous cardiac intervention or surgery, heart failure, coronary malperfusion syndrome, acute myocardial infarction, and severe aortic insufficiency, as well as concomitant coronary artery bypass grafting, tricuspid valve repair, and longer cardiopulmonary bypass and aortic crossclamp times but similar arch procedures. Perioperative outcomes were similar in the aortic root repair and aortic root replacement groups, including in-hospital mortality (8.5% and 8.2%), new-onset renal failure requiring permanent dialysis, stroke, myocardial infarction, and sepsis. Kaplan-Meier 10-year survival was 62% and 65%, and the 15-year cumulative incidence of reoperation was 11% and 7% in the aortic root repair and aortic root replacement groups, respectively. The primary indication for root reoperation was aortic root aneurysm in the aortic root repair group and bioprosthetic valve deterioration in the aortic root replacement group.Conclusions: Aortic root repair and aortic root replacement are appropriate surgical options for acute type A aortic dissection repair with favorable short-and long-term outcomes. Aortic root replacement should be performed for patients with acute type A aortic dissection presenting with an intimal tear at the aortic root, root aneurysm 4.5 cm or greater, connective tissue disease, or unrepairable aortic valvulopathy.

Management of malperfusion syndrome in acute type A aortic intramural hematoma

“…In conclusion, ATAAIMH patients with visceral/ extremity MPS could be managed with initial endovascular reperfusion of the vascular territories affected by malperfusion and delayed open aortic repair as our experience shows it achieves favorable short-and mid-term outcomes in this complex disease. RCP only 20 [25] 3 [33] 17 [24] Both ACP and RCP 14 [18] 3 [33] 11 [16] Neither ACP nor RCP 4 [ 1-2 13 [16] 2 [22] 11 [16] 3-4 15 [19] 2 [22] 13 [19] ≥5 24 [30] 2 [22] 22 [31] Data presented as median (interquartile range) for continuous variables and number (percentage) for categorical variables. MPS, malperfusion syndrome; TEVAR, thoracic endovascular aortic repair; AVR, aortic valve replacement; CABG, coronary artery bypass graft; MV, mitral valve procedure; TV, tricuspid valve procedure; CPB, cardiopulmonary bypass; HCA, hypothermic circulatory arrest; ACP, antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; PRBC, packed red blood cell.…”

“…All other patients underwent open aortic repair via a standard median sternotomy. Indications for root replacement included an intimal tear at the aortic root, root diameter ≥4.5 cm, connective tissue disease, and unrepairable aortic valve pathology (19). Root replacement was performed as a total root (BioBentall with Freestyle ) (n=7), inclusion root with a Freestyle bioprosthesis (n=4), or David valve-sparing aortic root replacement (n=2); all of which are current practice in our group.…”

Ameliyat öncesi ve sonrası dönemde komplike tip A aort diseksiyonunda günlük yaşam aktivitelerine dayalı hemşirelik bakımı: Olgu sunumu

“…Akut Tip-A diseksiyonu yüksek cerrahi morbidite ve mortalite ile seyreden bir hastalıktır ve cerrahi sonrası hastane içi 30 günlük mortalite oranı %8 ile %25 arasında değişmektedir. [1,[3][4][5] Mortalite ve morbidite riski yüksek bir hastalık olması yoğun bakım süreçlerinin uzaması ve dolayısıyla üst düzey bir yoğun bakım gereksiniminin ortaya çıkmasına yol açmaktadır. Hemşireliğin amacı bireylerin sağlığını korumak, geliştirmek ve hastalık durumunda iyileşmeyi ve bağımsızlığı kazanmasına yardım etmektir.…”

“…Hastalığın tedavisi hastanın klinik durumuna bakılmaksızın acil cerrahi işlem gerektirir. [1,[3][4][5] İskemik inmenin en önemli sebebi olarak görülen karotis arter diseksiyonu sıklıkla Tip-A aort diseksiyonuna sekonder olarak oluşmaktadır. [6] Bu olgu sunumunda nadir görülen sol karotis arteri de kapsayan Tip-A aort diseksiyon tanısıyla aort kapak replasmanı, asendan aort replasmanı ve sol karotis arter bypass grefti ameliyatı yapılan hastanın ameliyat öncesi ve sonrası dönemde günlük yaşam aktivitelerine dayalı hemşirelik modeline göre uygulanan hemşirelik bakımının değerlendirilmesi amaçlanmıştır.…”

Does adding a root replacement in type A aortic dissection repair provide better outcomes?

“…[4][5][6][7] Acute aortic dissection repair can necessitate a variety of operations, from simple replacement of the ascending aorta to aortic root replacement or a version of total arch replacement. There are differing opinions regarding what constitutes the "appropriate" repair of the acutely dissected aorta, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] a tear tailored approach is a trend that we normally follow; however, this is not generalizable across many different centers.…”