Aortic root surgery improves long-term survival after acute type A aortic dissection. (1st April 2015)

• Record Type: Journal Article
• Authors: Hysi, Ilir; Juthier, Francis; Fabre, Olivier; Fouquet, Olivier; Rousse, Natacha; Banfi, Carlo; Pinçon, Claire; Prat, Alain; Vincentelli, André
• Is Part Of: International journal of cardiology. Volume 184(2015)
• Page Start: 285
• Page End: 290
• Publication Date: 2015-04-01
• Subjects: Aortic dissection -- Aortic root -- Outcomes -- Root reoperation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.02.020
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objective: Our objective was to analyze the long term survival of patient operated on for acute type A aortic dissection. Methods: Between 1990 and 2010, 226 patients underwent emergency surgical operation for acute type A aortic dissection. We have followed the long-term outcomes. Results: 144 patients were operated on with a supracommissural replacement of the ascending aorta (SCR) and 82 with an aortic root surgery (ARS, including 77 Bentall procedures and 5 Tirone David operations). Aortic cross-clamp was longer in ARS group (150.8 vs. 103.6 min, p < 0.0001). Overall in-hospital mortality was lower in ARS group (20% vs. 34%, p 0.03). Median follow-up was 11.6 years. 10-year survival was higher in ARS group (85.7% vs. 65.9%, p 0.03) and 10-year freedom from aortic root reoperation was significantly lower in ARS group (93.4% vs. 82.9%, p 0.02). In a multivariate analysis aortic root surgery was an independent protective factor for proximal reoperations OR 0.393, CI 95% [0.206–0.748], p = 0.005. Conclusions: Our study suggests that complete aortic root replacement in type A aortic dissection does not burden short-term outcomes, improves long-term survivals and decreases the rate of late reoperation. Whether this approach has to be preferred in younger patient has to be demonstrated in further studies.