Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up.
OBJECTIVE
The objective of this study was to examine the fate of the native aortic root after replacement of the ascending aorta to treat acute type A aortic dissection.


METHODS
Between June 1985 and January 2010, 319 consecutive patients (mean age, 63 ± 11 years) with acute type A aortic dissection underwent replacement of the ascending aorta with preservation of the aortic root. The aortic valve was also replaced in 21 of these patients (7%). The intervention was extended to the aortic arch in 210 patients (66%), of whom 173 (54%) underwent hemiarch replacement, and 37 (12%), total arch replacement.


RESULTS
There were 109 (34%) in-hospital deaths. Of the 210 discharged patients, survival was 95%, 58%, and 27% at 1, 10, and 23 years, respectively. Freedom from reoperation on the proximal aorta was reported by 97%, 92%, and 82% patients at 5, 10, and 23 years, respectively. Twelve patients were reoperated for aortic root dilatation and 2 died during reoperation. Univariate and multivariate Cox regression analyses revealed that significant risk factors for proximal reoperation were age <60 years (P = .005; relative risk, 1.94) and Marfan syndrome (P = .011; relative risk, 2.76). At follow-up, 15 patients (11%) had an aortic root diameter of >45 mm, but they were not reoperated.


CONCLUSIONS
For acute type A aortic dissection, replacement of the ascending aorta with root preservation shows long-term effectiveness with low reoperation and aortic root dilatation rates.
Division of Cardiac Surgery, San Martino University Hospital, University of Genova, Genova, Italy.
Angelo M
AM
Dell'Aquila
Giovanni
G
Concistrè
Alina
A
Gallo
Stefano
S
Pansini
Alessandro
A
Piccardo
Giancarlo
G
Passerone
Tommaso
T
Regesta
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome