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Eur J Cardiothorac Surg 2007;31:41-42. doi:10.1016/j.ejcts.2006.10.016
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Editorial comment

Proximal reconstruction during Type A aortic dissection

Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, TX, United States

^_* Corresponding author. Address: Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, 6410 Fannin Street, Suite 450, Houston, TX 77030, United States. Tel.: +1 713 500 5420; fax: +1 713 500 0656. (Email: Anthony.l.estrera@uth.tmc.edu).

The first 20% of the full text of this article appears below.

In the paper by Farhat and colleagues [1], 15 patients with Type A aortic dissection were repaired using the valve sparing aortic root replacement (reimplantation or David procedure) for the proximal aortic reconstruction. The authors report an excellent early mortality of 7% and a 2-year actuarial survival of 93%. In their conclusion, the authors proposed that the ‘systematic’ use of this technique is recommended for repairs of Type A aortic dissection. In such a small series, the data presented does not support this conclusion, but we credit the authors for bringing our attention to a continuing question: What is the best management strategy for the aortic root during acute Type A aortic dissection?

At experienced centers outcomes during repair of acute Type A aortic dissection have improved and more complex procedures are being performed. Many centers have previously reported results of the reimplantation technique with acceptable early outcomes for acute dissection [2]. Thus, the question of whether this technique can be performed safely in the setting of acute aortic dissection – the stated aim of this study – has been previously answered. A more . . . [Full Text of this Article]