Aortic Root Surgery in Acute Aortic Dissection Type A: Comparison of Aortic Valve-sparing Repair versus Composite Grafting

Objective: This retrospective single center study compares the outcomes of aortic valve-sparing technique (AVS) and aortic root replacement with composite grafting (COMP) in patients with acute aortic dissection type A (AADA).

Patients and Methods: From 1988 until 2016, 200 patients (152 male, 48 female, mean follow-up 6.2 years) underwent emergent aortic root surgery for AADA with COMP (n = 163, mean age: 54.5 years) or AVS (n = 37, mean age 55.5 years, David, n = 23 and Yacoub n = 14) at our institution. Clinical presentation, perioperative complications and surgical outcomes were compared between patients with COMP and patients with AVS.

Results: There were no significant differences in patient characteristics between both groups. Operation times were comparable, however, frozen elephant trunk was more often applied with AVS (p = 0.039). AVS patients had shorter mean stay on intensive care unit (p < 0.01), shorter ventilation time (p = 0.05), less blood transfusions (p < 0.01) and less renal replacement therapy (p = 0.035) compared with COMP patients. Intraoperative (COMP 9.2%, AVS 5.4%, p = 0.455), 30-day (COMP 23.6%, AVS 14.5%, p = 0.320), and 5-year mortality (COMP 38.1%, AVS 21.6%, p = 0.058), were comparable in both groups. However, long-term survival was superior in AVS patients (p = 0.032). Need for aortic root re-do surgery (COMP 1.2%, AVS 5.4%) was comparable in both groups (p = 0.165).

Conclusion: Aortic valve-sparing technique can be performed safely in AADA patients and is associated with shorter recovery time, fewer early complications and shows favorable long-term survival.