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Ann Thorac Surg 1999;67:2010-2013
© 1999 The Society of Thoracic Surgeons
a Division of Cardiac Surgery, University of Verona, Verona, Italy
Address reprint requests to Dr Pessotto, Department of Cardiac Surgery, University of Verona, OCM Borgo Trento, P.le Stefani 1, 37126, Verona, Italy
Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.
Background. The aim of the present study was to verify the efficacy of preserving the aortic valve in patients with acute type A aortic dissection complicated by significant aortic regurgitation.
Methods. From January 1979 to December 1996, 178 patients (125 males; mean age 57 ± 9 years) underwent emergency surgery for acute type A aortic dissection, with an overall operative mortality rate of 21%. Based on a retrospective analysis of the preoperative angio- or echocardiographic findings, the 141 survivors were divided into 2 groups: Group 1 (G1) included 80 patients (57%) with no or mild aortic regurgitation, and Group 2 (G2) the remaining 61 patients with moderate-to-severe aortic regurgitation. The native aortic valve was preserved by means of a uniform technique consisting of reconstruction of the aortic root and sinotubular junction in 99 patients (70%) [68 in G1 (85%) and 31 in G2 (51%)]. Forty-two patients required aortic valve (8 patients; 6%) or total root replacement (34 patients; 24%).
Results. At a mean follow-up of 4 ± 3.6 years (range, 6 months to 19 years), 19 of the 99 patients with a preserved aortic valve developed moderate-to-severe aortic insufficiency [19%; 7/68 in G1 (10%) and 12/31 in G2 (39%)]. Multivariate analysis revealed that moderate-to-severe preoperative aortic valve insufficiency was a significant risk factor for development of postoperative aortic valve regurgitation (p= 0.008). Reoperation was necessary in 7 G1 patients (10%) and in 8 G2 patients (26%), with an actuarial freedom from reoperation at 5 and 10 years of 93% ± 7% and 80% ± 9% in G1 patients, and 81% ± 8% and 40% ± 15% in G2 patients (p = 0.045).
Conclusions. Preservation of the aortic valve and aortic root is recommended in patients with acute type A aortic dissection and absent or mild aortic insufficiency. Patients presenting with moderate-to-severe aortic regurgitation and treated conservatively present an increased risk of recurrent valvular insufficiency.
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