Aortic root surgery improves long-term survival after acute type A aortic dissection.
OBJECTIVE
Our objective was to analyze the long term survival of patient operated on for acute type A aortic dissection.


METHODS
Between 1990 and 2010, 226 patients underwent emergency surgical operation for acute type A aortic dissection. We have followed the long-term outcomes.


RESULTS
144 patients were operated on with a supracommissural replacement of the ascending aorta (SCR) and 82 with an aortic root surgery (ARS, including 77 Bentall procedures and 5 Tirone David operations). Aortic cross-clamp was longer in ARS group (150.8 vs. 103.6 min, p<0.0001). Overall in-hospital mortality was lower in ARS group (20% vs. 34%, p 0.03). Median follow-up was 11.6 years. 10-year survival was higher in ARS group (85.7% vs. 65.9%, p 0.03) and 10-year freedom from aortic root reoperation was significantly lower in ARS group (93.4% vs. 82.9%, p 0.02). In a multivariate analysis aortic root surgery was an independent protective factor for proximal reoperations OR 0.393, CI 95% [0.206-0.748], p=0.005.


CONCLUSIONS
Our study suggests that complete aortic root replacement in type A aortic dissection does not burden short-term outcomes, improves long-term survivals and decreases the rate of late reoperation. Whether this approach has to be preferred in younger patient has to be demonstrated in further studies.
Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, Department of Cardiovascular Surgery, France.
Ilir
I
Hysi
Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, Department of Cardiovascular Surgery, France.
Francis
F
Juthier
Centre Hospitalier de Lens et Hôpital privé de Bois Bernard, Lens, Department of Cardiac surgery, France.
Olivier
O
Fabre
Centre Hospitalier Universitaire d'Angers, Angers 42000, Department of Cardiovascular and Thoracic surgery, France.
Olivier
O
Fouquet
Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, Department of Cardiovascular Surgery, France.
Natacha
N
Rousse
Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, Department of Cardiovascular Surgery, France.
Carlo
C
Banfi
Université Lille Nord de France, Lille 59000, UDSL, EA2694, Department of Biostatistics, France.
Claire
C
Pinçon
Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, Department of Cardiovascular Surgery, France.
Alain
A
Prat
Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, Department of Cardiovascular Surgery, France. Electronic address: an.vincentelli@gmail.com.
André
A
Vincentelli
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Aortic dissection; Aortic root; Outcomes; Root reoperation