title: Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection.
abstract: BACKGROUND
  Acute type A aortic dissection frequently occurs in patients with normally sized aortic roots. The aim of this investigation was to describe the durability of aortic valve resuspension and root repair with a novel technique of reconstruction in type A dissection.
  
  
  METHODS
  From 1993 to 2013, among 629 patients operated on for acute type A dissection 489 (62% male, median age 62 years (53; 73) underwent aortic valve resuspension and reinforcement of the sinus of Valsalva with a Teflon felt neomedia. The median follow-up time was 4.1 years (1.3; 6.8) (2075 patient-years).
  
  
  RESULTS
  In-hospital mortality was 11% (56/489). Survival was 69%±2%, 50%±3%, and 36%±5% at 5, 10, and 15 years, respectively. Freedom from moderate or severe aortic regurgitation was not influenced by the aortic regurgitation grade at the initial operation (p=0.131). Freedom from proximal aortic reoperation was 96%±1%, 92%±2%, and 89%±4% at 5, 10, and 15 years, respectively. Seventeen patients (3%) required proximal reoperation: 10 for aortic regurgitation, including 3 with concomitant pseudoaneurysm and 2 with root aneurysm; 6 for pseudoaneurysm; and 1 for graft infection.
  
  
  CONCLUSIONS
  Aortic root neomedia reconstruction and valve resuspension can be successfully performed in the majority of patients with type A dissection. The in-hospital mortality is low, and the results are durable.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Heart Center Freiburg University, Freiburg, Germany. Electronic address: bartosz.rylski@universitaets-herzzentrum.de.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Rylski
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rita K
authors.initials: RK
authors.lastname: Milewski
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Moser
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Emily
authors.initials: E
authors.lastname: Kremens
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods