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Ann Thorac Surg 2001;71:1244-1249
© 2001 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
Accepted for publication October 30, 2000.
Address reprint requests to Dr Moon, Division of Cardiothoracic Surgery, Washington University School of Medicine, 3108 Queeny Tower, 1 Barnes-Jewish Plaza, St. Louis, MO 63110-1013
e-mail: moonm{at}msnotes.wustl.edu
Background. The extent of proximal and distal aortic resection that should be performed for acute type A aortic dissections remains controversial.
Methods. From 1984 to 1999, 119 patients underwent repair of an acute type A dissection. Distal resection was to the ascending aorta in 78 (66%) and hemiarch in 41 (34%) patients. Proximally, the aortic valve was preserved in 69 (58%) patients, 40 (34%) underwent composite valve grafting, and 10 (8%) underwent separate graft and valve replacement.
Results. Operative mortality was higher for separate graft and valve (50% ± 16%) than for valve preservation (16% ± 5%) or composite grafts (20% ± 7%) (p < 0.05). Hemiarch replacement did not increase operative risk compared to distal reconstruction to the ascending aorta (17% ± 6% versus 22% ± 5%, p > 0.71). At 10 years, freedom from reoperation was 81% ± 7% and long-term survival was 60% ± 8%, but neither was related to the proximal or distal surgical technique (p > 0.15). Risk factors for late reoperation included a nonresected primary tear and Marfan syndrome (p < 0.05).
Conclusions. An aggressive surgical approach, including a full root or hemiarch replacement, is not associated with increased operative risk and should be considered when type A dissections extensively involve the valve, sinuses, or arch.
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Ann. Thorac. Surg. 2001 71: 1249-1250.
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