title: Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis.
abstract: OBJECTIVE
  Surgical management of the aortic root in type A acute aortic dissection (TAAAD) is controversial. This study compares short- and long-term outcomes of root replacement (RR) versus conservative root management (CR).
  
  
  METHODS
  Between 1999 and 2014, 296 patients with TAAAD were treated in our department. The mean age was 63.7 years. Of the total, 69% were male. Ten patients (3%) presented with Marfan syndrome or bicuspid aortic valve. RR was performed in 119 (40%) patients, whereas CR in 177 (60%). Pre- and intraoperative data were stratified according to root management, and treatment bias was addressed by propensity-score (PS) analysis. Independent predictors of hospital and long-term mortality and proximal aortic reoperation were identified using multivariable logistic and Cox regression models.
  
  
  RESULTS
  Using PS analysis, we obtain two groups of 82 patients. The matched cohort hospital mortality rate was 21% in the CR group and 26% in the RR group (P = 0.45). The unadjusted comparison showed no statistical difference in early and long-term mortality between the groups. This result was confirmed after standard logistic regression and propensity-adjusted logistic regression. Freedom from proximal aortic reintervention was higher in the RR group (at 7 years RR: 96 ± 3% vs CR: 80 ± 6%, log-rank P = 0.02) and remained high in the matched cohort of patients (at 7 years RR: 98 ± 2 vs CR: 86 ± 6, log-rank P = 0.06).
  
  
  CONCLUSIONS
  Conservative and aggressive root management in acute aortic dissection provided similar results for early and late mortality. Nevertheless, a more extensive root intervention appeared to be protective against aortic reintervention.
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy davide.pacini@unibo.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Marco
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Berretta
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Cefarelli
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Murana
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Alfonsi
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pantaleo
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Leone
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Aortic dissection; Aortic operation; Aortic root; Propensity matching; Statistics