European Journal of Cardio-Thoracic Surgery, Vol 10, 840-844, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Radical replacement of the aortic root in acute type A dissection: indications and outcome
MA Ergin, J McCullough, JD Galla, SL Lansman and RB Griepp
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029, USA.
OBJECTIVE: Failure of the repair at the proximal aorta is an important
cause of morbidity and mortality following surgical treatment of acute type
A dissection. This review was undertaken to determine the influence of
total composite replacement of the ascending aorta and the root on the
operative risk and long-term survival. METHODS: In a consecutive series of
73 patients with acute type A dissections between 1985 and 1994, 19 (26%)
patients with radical root replacement (group I) were compared with 54
patients who had conventional valve-preserving root reconstruction (group
II). RESULTS: Group I represented a higher operative risk with the presence
of significant aortic regurgitation (13/19 68.4% vs 23/54 42.5% P <
0.05), aortic dilatation (19/19 100% vs 32/54 59.2% P < 0.00), and
coronary dissection (13/19 68.4% vs 3/54 5.5% P < 0.000). In spite of
this there was no difference in operative mortality (3/19 15.7% vs 7/54
12.9%, NS) or the occurrence of major postoperative complications: bleeding
(3/19 15.7% vs 7/54 12.9%, NS), respiratory (5/19 26.3% vs 11/54 20.3%,
NS), stroke (2/19 10.5% vs 3/54 5.5%, NS). Patients with radical root
replacement had substantially better event-free survival at 5 years (87.5%
+/- 11.7% vs 67.1% +/- 8.9%) and 9 years (87.5% +/- 21.9% vs 63.0% +/-
19.2%). CONCLUSIONS: This experience confirms that, in the treatment of
acute type A dissection, an aggressive approach to aortic root pathology is
indicated for specific indications, and can be carried out with good early
and excellent long-term results.
