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Related Experiment Video

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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Long-term effectiveness of operations for ascending aortic dissections.

J F Sabik1, B W Lytle, E H Blackstone

  • 1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. sabikj2ccf.org

The Journal of Thoracic and Cardiovascular Surgery
|May 2, 2000
PubMed
Summary

This study shows that managing ascending aortic dissection with specific surgical strategies, including valve resuspension and supracoronary repair, leads to effective long-term outcomes. Residual distal dissection does not negatively impact survival, with low reoperation risk.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Ascending aortic dissection requires tailored surgical management based on pathology.
  • Long-term effectiveness of specific aortic root and distal aorta management strategies is crucial.

Purpose of the Study:

  • To evaluate the long-term effectiveness of a strategy for managing the aortic root and distal aorta in ascending aortic dissection.
  • To assess outcomes based on pathological findings.

Main Methods:

  • Analysis of 208 patients (acute and chronic dissection) operated between 1978-1995.
  • Surgical strategies included valve resuspension, supracoronary aortic root repair, composite grafts, and valve replacement.
  • Arch resection was performed only if the intimal tear involved the arch.

Main Results:

  • Hospital mortality was 14%; cardiogenic shock and CABG increased risk, while circulatory arrest decreased risk.
  • Long-term survival was 87% (30-day), 68% (5-year), and 52% (10-year).
  • Advanced age, earlier operation date, composite grafts, and arch resection were linked to decreased survival; residual distal aorta did not impact survival.

Conclusions:

  • Circulatory arrest is associated with low early mortality in ascending aortic dissections.
  • Supracoronary repair and valve resuspension are effective long-term for normal sinuses and valves.
  • Residual distal dissected aorta does not reduce late survival and has a low risk of complications.