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Ann Thorac Surg 2000;70:1460-1465
© 2000 The Society of Thoracic Surgeons

Original articles: cardiovascular

Valve-preserving operation in acute aortic dissection type A

Thomas P. Graeter, MDa, Frank Langer, MDa, Nikolaus Nikoloudakis, MDa, Diana Aicher, MDa, Hans-Joachim Schäfers, MD, PhDa

a Department of Thoracic and Cardiovascular Surgery, University Hospitals, Homburg/Saar, Germany

Address reprint requests to Dr Schäfers, Department of Thoracic and Cardiovascular Surgery, University Hospitals, 66421 Homburg/Saar, Germany
e-mail: chhjsc{at}med-rz.uni-sb.de

Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.

Background. The standard treatment in patients with acute aortic dissection type A (AADA) and aortic regurgitation is either supracommissural aortic or composite replacement of ascending aorta and valve. Valve-preserving surgical procedures provide a promising alternative. We retrospectively analyzed midterm results after these different approaches.

Methods. From October 1995 to December 1999, 52 patients (35 men, 17 women) underwent repair of AADA. Patient ages ranged from 30 to 83 years. Composite replacement was chosen for degenerated aortic valves or prior valve replacement (group A; n = 8). With normal root diameter, supracommissural replacement of the ascending aorta was performed (group B; n = 22). For preexisting root dilatation the aortic root was either remodeled (root diameter 30 to 50 mm, group C; n = 17) or the valve reimplanted within a vascular graft (root diameter more than 50 mm, group D; n = 5).

Results. All patients underwent either proximal (n = 46) or total (n = 6) arch replacement under circulatory arrest. Eight patients (15.4%) died (group A: n = 3; group B: n = 3; group C: n = 2). Freedom from aortic regurgitation of grade 2 or more at 2 years was 100% in groups A and D, 90.9% in group C, and 75% following supracommissural replacement. At 2 years freedom from proximal reoperation was 100% in groups A, C, and D and 84.5% in group B.

Conclusions. In AADA valve-preserving root replacement leads to improved stability of aortic valve function without an increased operative risk. Midterm results are promising and may show further superiority over supracommissural aortic replacement in the future.


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Discussion
Ann. Thorac. Surg. 2000 70: 1465. [Extract] [Full Text] [PDF]



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