title: Comparison of Left Ventricular Volume and Ejection Fraction and Frequency and Extent of Aortic Regurgitation After Operative Repair of Type A Aortic Dissection Among Three Different Surgical Techniques.
abstract: Differences in recurrence rate of aortic regurgitation (AR) and extent of left ventricular (LV) remodeling across the different surgical options in patients operated for type A aortic dissection remain unknown. The present evaluation compared the AR recurrence rate and changes in LV volumes and systolic function in valve-sparing aorta replacement (VSAR), supracoronary ascending aorta replacement (SCAR), and aortic valve and aorta replacement (AVAR). A total of 97 patients (58 ± 12 years, 62% men) with acute type A aortic dissection who underwent VSAR (n = 24), SCAR (n = 43), or AVAR (n = 30) were evaluated. Changes in LV volumes and function between postoperative and follow-up were compared using linear mixed models. Postoperative AR grades were not significantly different between groups. However, after median follow-up of 47 months, AR grade ≥2 was significantly more often observed in SCAR (55%) and VSAR (25%) compared to AVAR (0%, p <0.001). LV volumes remained stable in VSAR and AVAR but increased significantly in SCAR (LV end-diastolic volume: from 99 ± 4 to 131 ± 6 ml; p <0.001; LV end-systolic volume: from 49 ± 3 to 66 ± 5 ml; p = 0.002). In patients with recurrent AR grade ≥2 at follow-up, LV volumes increased, whereas patients without recurrent AR did not show significant LV dilatation. In conclusion, patients with acute type A aortic dissection who underwent SCAR or VSAR showed more frequently AR grade ≥2 recurrence compared to AVAR. However, only patients who underwent SCAR experienced adverse LV remodeling at follow-up. Recurrence of AR grade ≥2 was associated with adverse LV remodeling.
authors: Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Madelien V
authors: MV
authors: Regeer
authors: Department of Cardiothoracic Surgery, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Michel I M
authors: MI
authors: Versteegh
authors: Department of Cardiothoracic Surgery, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Robert J M
authors: RJ
authors: Klautz
authors: Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Martin J
authors: MJ
authors: Schalij
authors: Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Jeroen J
authors: JJ
authors: Bax
authors: Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
authors: Nina Ajmone
authors: NA
authors: Marsan
authors: Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: v.delgado@lumc.nl.
authors: Victoria
authors: V
authors: Delgado
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling