Valve-sparing aortic root replacement (remodeling/reimplantation) in acute type A dissection.
BACKGROUND
High reoperation rates after supracommissural tube graft replacement for acute type A dissection due to sinus of Valsalva dilation have been reported. Valve-sparing operations focusing on the replacement of the sinus of Valsalva are an appealing alternative. The applicability of these techniques in acute type A dissection remains debatable and results are limited.


METHODS
From 1992 to 1998, 20 patients with acute type A dissection received a valve-sparing aortic root replacement. Two different types of aortic valve-sparing operations were performed: the remodeling technique in 11 patients and the reimplantation technique in 9 patients. Patients were followed for 26 +/- 18 months. Echocardiographic studies were performed every 6 months.


RESULTS
There were 2 early postoperative deaths and no late death, no reoperation, and no thromboembolic events. The latest echocardiographic studies of the 18 survivors showed a competent valve in 12 and a trivial aortic valve insufficiency in 6 patients. The mean aortic valve pressure gradient was 4.3 +/- 1.3 mm Hg.


CONCLUSIONS
These midterm results support the surgical strategy of valve-sparing aortic root replacement in patients with acute type A dissection.
Department of Cardiac Surgery, University of Lübeck, Germany.
R G
RG
Leyh
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C
Schmidtke
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C
Bartels
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HH
Sievers
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001021:Aortic Valve; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000379:methods