title: Long-term outcomes of survival and freedom from reoperation on the aortic root or valve after surgery for acute ascending aorta dissection.
abstract: OBJECTIVE
  Limited long-term outcome data are available on survival and the need for aortic root or valve reoperation after surgery for acute ascending aorta dissection. We report our 42-year experience.
  
  
  METHODS
  We reviewed the records of 269 patients who had undergone surgery for acute ascending aorta dissection from July 1969 to June 2011. The mean age at surgery was 62.1±15.2 years, and 181 were men (67.3%). The distal operation was limited to hemiarch replacement. The proximal aortic operation groups included a composite valve conduit in 66 patients (24.5%), aortic root repair in 112 (41.6%), and isolated supracoronary ascending aorta replacement in 91 (33.8%).
  
  
  RESULTS
  Operative morbidity occurred in 224 patients (83.3%) and mortality in 44 (16.4%), with similar rates among the groups (P=.894 and P=.466, respectively). The mean follow-up was 9.7±7.5 years. The Kaplan-Meier survival estimate at 10 and 20 years was 65.5%±3.6% and 28.7%±4.3%, respectively, and was similar among the groups (P=.227). Reoperation on the aortic root or valve occurred in 20 patients (8.9%) at a median of 6.8 years (range, 0.2-20.3). The freedom from reoperation rate at 10 and 20 years was 91.5%±2.3% and 79.3%±6.1%, respectively, with no difference among the groups (P=.605).
  
  
  CONCLUSIONS
  Operative morbidity and mortality rates are significant after repair of acute ascending aorta dissection. Aortic root surgery can be performed without an apparent increase in the prevalence of operative morbidity or mortality; however, patients remain at risk of subsequent aortic root or valve surgery.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn; Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors: Zhengjun
authors: Z
authors: Wang
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: greason.kevin@mayo.edu.
authors: Kevin L
authors: KL
authors: Greason
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Alberto
authors: A
authors: Pochettino
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Hartzell V
authors: HV
authors: Schaff
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Rakesh M
authors: RM
authors: Suri
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: John M
authors: JM
authors: Stulak
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Joseph A
authors: JA
authors: Dearani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult