title: Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection.
abstract: BACKGROUND
  The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure.
  
  
  METHODS
  All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution's Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed.
  
  
  RESULTS
  The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p= 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p= 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p= 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rankp= 0.035).
  
  
  CONCLUSIONS
  The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.
authors.affiliation: Department of Cardiothoracic Surgery, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Gunn
authors.affiliation: Department of Cardiothoracic Surgery, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Stamou
authors.affiliation: Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, Missouri, USA.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lobdell
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery and The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kamal
authors.initials: K
authors.lastname: Khabbaz
authors.affiliation: Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, Michigan, USA.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Patzelt
authors.affiliation: Department of Cardiac Surgery, Hartford Hospital, Hartford, Connecticut, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hagberg
keywords: Aorta; Aortic aneurysm; Aortic root; Aortic valve