The Aortic Root in Acute Type A Dissection: Repair or Replace?

Friday, June 23, 2023

Submitted by

Cameron Lind

Source

Source Name: The Annals of Thoracic Surgery

Source URL: https://www.annalsthoracicsurgery.org/article/S0003-4975(22)00970-5/fulltext

Author(s)

Arabkhani, Klautz, and coauthors

This single-center study of 299 patients operated on for type-A aortic dissection between 1992 and 2020 reported lower ten-year mortality (32 percent) after prosthetic or valve-sparing root replacement compared with ascending aorta replacement (52 percent; hazard ratio, 1.38; 95 percent CI, 1.12-1.68) without resecting the coronary sinuses, and lower proximal aorta reoperation rates (14 percent vs 23 percent; hazard ratio, 2.08; 95 percent CI, 1.44-5.56). The authors conclude that aortic root replacement should be considered when the aortic root is partially dissected or pathologically dilated.

Comments

Submitted by Jeng Wei on Fri, 2023-06-23 23:09

The most important consideration is whether the surgical team can perform complex surgeries. Generally, if dissection leads to severe aortic valve regurgitation, but the valve structure appears normal, I will choose total arch replacement combined with the David procedure. However, if the patient's condition is poor, they are older, or the aortic valve is not in good condition, I would opt for the Bentall procedure.