title: Durability of aortic valve preservation with root reconstruction for acute type A aortic dissection.
abstract: OBJECTIVE
  We evaluated the durability of aortic valve preservation with root reconstruction for acute type A aortic dissection (AAAD).
  
  
  METHODS
  From January 2002 to March 2011, 140 patients [70 males, 68 ± 12 (SD) years] underwent emergency operation for AAAD. The aortic valve was preserved and one or more Valsalva sinuses were reconstructed. Techniques used for reconstruction were valve resuspension and additional reinforcement of the aortic root with Teflon felt patches, and gelatin-resorcinol-formaldehyde-glue (GRF-glue) was used for mending the dissection. The mean follow-up period was 44.0 ± 26.2 months. We classified the degree of aortic regurgitation (AR) into four grades (0, 1+, 2+ and 3+) using echocardiography. Based on a retrospective analysis of pre-operative echocardiographic findings, the 127 survivors were divided into two groups: group 1 (G1) included 98 patients with 0 or 1+ AR, and group 2 (G2) 29 patients with 2+ or 3+ AR. In addition, we measured the post-operative native aortic root dimension of AAAD patients with use of echocardiography or CT scan.
  
  
  RESULTS
  The operative mortality rate was 9.3% (13/140). Freedom from aortic root re-operation was 100%. Aortic root pseudoaneurysm formation and severe AR requiring aortic valve replacement did not occur. Pre-operative AR of 0.2 ± 0.4 in G1 did not deteriorate (0.5 ± 0.5 at discharge, 0.4 ± 0.4 at follow-up). Meanwhile, pre-operative AR of 2.4 ± 0.5 in G2 improved to 0.6 ± 0.5 (P < 0.05) at discharge and 1.0 ± 0.6 (P < 0.05) at follow-up. The native aortic root dimension in G2 at follow-up was significantly larger than G1 (36.0 ± 4.7 vs. 33.9 ± 5.0 mm).
  
  
  CONCLUSIONS
  Aortic valve preservation and root reconstruction appear to be an appropriate surgical approach to AAAD.
authors.affiliation: Division of Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, Japan. yamanaka@tenriyorozu.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hori
authors.forename: Jin
authors.initials: J
authors.lastname: Ikarashi
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Kusuhara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakatsuka
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hirose
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishina
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Fujita
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001011:Aorta / Q000473:pathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004630:Emergencies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012850:Sinus of Valsalva / Q000601:surgery; D016896:Treatment Outcome