title: Aortic root remodeling leads to good valve stability in acute aortic dissection and preexistent root dilatation.
abstract: To evaluate the long-term results of aortic root remodeling in the setting of acute aortic dissection type A (AADA).
  
  
  
  Between October 1995 and May 2013, a total of 215 patients were treated surgically for AADA. Of these, 59 patients with AADA (<2 weeks from onset, age 56 ± 16 years, 53 males) with a root diameter of ≥43 to 45 mm (depending on patient size) underwent aortic root remodeling and were analyzed further. Reimplantation was performed in 7 patients; root replacement with a mechanical composite graft, in 16 patients; root replacement with a stentless biological prosthesis, in 10 patients; and tubular ascending aortic replacement, in 133 patients.
  
  
  
  Reexploration for bleeding was performed in 10 patients (17%; 8% since 2007). Early mortality was 6.8%; no patient died after 2002. Actuarial survival at 10 years was 72% ± 6%. One patient underwent aortic valve replacement for recurrent cusp prolapse at 1 year after surgery. In this operation, cusp configuration was assessed by eyeballing until 2003. The rate of freedom from proximal reoperation at 10 years was 98% ± 2%. Using a Cox proportional hazards model, no independent predictors for survival and reoperation after remodeling were found. Advanced age and concomitant coronary artery bypass grafting were identified as independent predictors for survival in all 215 patients with AADA.
  
  
  
  Root remodeling allows for stable valve preservation in patients with AADA and preexistent root dilatation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Neumann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Steffen Daniel
authors.initials: SD
authors.lastname: Kriechbaum
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany. Electronic address: h-j.schaefers@uks.eu.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D066253:Vascular Remodeling
keywords: acute aortic dissection; aortic root remodeling; valve-preserving root surgery