title: Clinical outcomes of valve-sparing root replacement in acute type A aortic dissection.
abstract: OBJECTIVE
  The early and late outcomes of valve-sparing root replacement (VSR) in type A aortic dissection (AAD) are unknown. The aim of this study was to review the outcomes of VSR in AAD. We also compared the outcomes of VSR with the Bentall operation, which served as a standard reference technique.
  
  
  METHODS
  We retrospectively reviewed 52 patients who underwent surgery for AAD and concomitant root replacement between 1998 and 2013 at Samsung Medical Center. Patients were divided into two groups: Bentall (n = 34) and VSR (n = 18). Two out of six surgeons performed VSR. The mean follow-up duration was 62.3 ± 46.5 months.
  
  
  RESULTS
  Preoperative characteristics were similar between the two groups except age (Bentall, 48 ± 11 years; VSR, 37 ± 11 years, p = 0.011). The aortic cross-clamping time was longer in the VSR group (Bentall, 185.8 ± 63.8; VSR, 241.4 ± 44.3 min, p = 0.002). There was no early death in the VSR group, but there was one in the Bentall group (p = 1.000). Despite the higher reoperation rate for aortic valve in the VSR group (Three reoperations) than in the Bentall group (no reoperation), major valve-related events and overall mortality did not differ between the two groups(p = 0.876 and 0.119, respectively). In multivariable analysis, the root replacement technique was not a risk factor for major valve-related events.
  
  
  CONCLUSIONS
  VSR seems to be equivalent to the Bentall procedure for AAD in terms of early and late outcomes. VSR can be considered as a viable option, particularly for young patients with favorable aortic valve leaflets undergoing surgery at an experienced center.
authors.affiliation: a Department of Thoracic and Cardiovascular Surgery , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
authors.forename: Heemoon
authors.initials: H
authors.lastname: Lee
authors.affiliation: a Department of Thoracic and Cardiovascular Surgery , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
authors.forename: Yang Hyun
authors.initials: YH
authors.lastname: Cho
authors.affiliation: a Department of Thoracic and Cardiovascular Surgery , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
authors.forename: Kiick
authors.initials: K
authors.lastname: Sung
authors.affiliation: a Department of Thoracic and Cardiovascular Surgery , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.affiliation: b Department of Thoracic and Cardiovascular Surgery , Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , Korea.
authors.forename: Kay-Hyun
authors.initials: KH
authors.lastname: Park
authors.affiliation: a Department of Thoracic and Cardiovascular Surgery , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
authors.forename: Pyo Won
authors.initials: PW
authors.lastname: Park
authors.affiliation: a Department of Thoracic and Cardiovascular Surgery , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; 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; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012092:Replantation; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic dissection; aortic root; aortic root replacement; aortic valve sparing operation; reimplantation