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Updated: May 2, 2026
12:17
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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High failure rate after valve-sparing aortic root replacement using the "remodeling technique" in acute type A aortic
Rainer G Leyh1, Stefan Fischer, Klaus Kallenbach
1Division of Thoracic and Cardiovascular Surgery, Hanover Medical School, Hanover, Germany. leyh@thg.mh-hannover.de
Circulation
|October 2, 2002
Summary
Valve-sparing aortic root replacement for acute type A aortic dissection showed mixed results. Aortic root reimplantation yielded favorable midterm outcomes, while remodeling had a high failure rate, questioning its use in this patient group.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Management
Background:
- Valve-sparing aortic root replacement (VSARR) is a surgical approach for acute type A aortic dissection.
- Long-term outcomes of VSARR in acute type A aortic dissection remain debated due to limited evidence.
- This study reports on the authors' experience with VSARR in patients diagnosed with acute type A aortic dissection.
Purpose of the Study:
- To evaluate the early and late outcomes of valve-sparing aortic root replacement in patients with acute type A aortic dissection.
- To compare the efficacy of two VSARR techniques: remodeling and reimplantation.
- To assess aortic valve-related complications and reoperation rates following VSARR for acute type A aortic dissection.
Main Methods:
- A cohort of 30 patients with acute type A aortic dissection underwent valve-sparing aortic root replacement between August 1995 and November 2000.
- Two techniques were employed: aortic root remodeling (8 patients) and aortic root reimplantation (22 patients).
- Outcomes assessed included early/late mortality, valve-related complications, and reoperations.
Main Results:
- Mean follow-up was 22.6 months. 30-day mortality was 17% (5/29), and late mortality was 4% (1/24).
- Three patients (after remodeling) required reoperation for acute aortic valve regurgitation due to commissural detachment; one patient (after reimplantation) needed reoperation for endocarditis.
- Echocardiographic follow-up showed freedom from >grade 1 aortic regurgitation in other patients.
Conclusions:
- Aortic root remodeling demonstrates a high failure rate in acute type A aortic dissection, raising concerns about its applicability.
- Aortic root reimplantation offers favorable midterm results for acute type A aortic dissection.
- Reimplantation technique is recommended for surgical consideration in patients with acute type A aortic dissection.
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