Strategies for treatment of acute aortic dissection with involvement of sinus of valsalva.
OBJECTIVE
The aim of this study was to assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA) with involvement of the aortic root.


METHODS
From November 2002 to December 2007, 51 consecutive patients underwent emergency surgical intervention for AADA with involvement of the aortic root. Supracommissural replacement (SCR) of the ascending aorta was applied to 33 of these patients; 12 cases received a Bentall procedure, and 6 underwent partial remodeling technique in which as much as the dissected aortic root was resected, leaving a rim of 10 mm above the noncoronary annulus and 5 mm above the coronary ostia and commissures. Woven Dacron graft tailored in a scallop-shaped configuration to match the noncoronary sinus was then anastomosed to the proximal aortic stump.


RESULTS
Overall hospital mortality was 16% and showed no significant differences among groups. SCR showed a trend toward higher aortic root morbidity. Mean operation time, cardiopulmonary bypass time, and cardiac ischemia time were significantly longer for the Bentall procedure.


CONCLUSIONS
In AADA involving aortic root, a partial remodeling technique may be considered the surgical treatment of choice at our institution in suitable patients.
Fujimatsu
Toshihiro
T
Department of Cardiovascular Surgery, Heart Center, Aizawa Hospital, Matsumoto, Japan.
Osawa
Hajime
H
Osaka
Shinichi
S
Takai
Fumie
F
Hashimoto
Masaki
M
Suzuki
Hiroyuki
H
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome