title: Valve-sparing root reconstruction does not compromise survival in acute type A aortic dissection.
abstract: BACKGROUND
  The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures.
  
  
  METHODS
  The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate.
  
  
  RESULTS
  From March 1995 to April 2010, 208/374 patients (56%) undergoing AAAD repair received an aortic root procedure. Group 1 (n=130) underwent a Bentall operation, group 2 (n=51) underwent a modified Yacoub procedure, and group 3 (n=27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27%; group 2, 16%; group 3, 15%). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score=-0.279; p>0.05). Five-year survival estimates were 66% for group 1, 65% for group 2, and 80% for group 3 (log rank p=0.2).
  
  
  CONCLUSIONS
  Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.
authors: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. ssubramanian@surgery.arizona.edu
authors: Sreekumar
authors: S
authors: Subramanian
authors: Sergey
authors: S
authors: Leontyev
authors: Michael A
authors: MA
authors: Borger
authors: Constanze
authors: C
authors: Trommer
authors: Martin
authors: M
authors: Misfeld
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality* / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012092:Replantation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome