Composite aortic root replacement in acute type A dissection: time to rethink the indications?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Indications for aortic root replacement in acute type A aortic dissection remain unclear.
• A low-threshold policy for composite aortic root replacement has evolved in some centers.

Purpose of the Study:

• To review the immediate and long-term outcomes of patients undergoing aortic root replacement versus supracoronary interposition grafting for acute type A dissection.
• To evaluate the effectiveness of an aggressive composite aortic root replacement strategy.

Main Methods:

• A prospectively compiled database identified 162 patients with acute type A dissection, divided into supracoronary interposition grafting (Group A, n=89) and composite root replacement (Group B, n=73).
• Patients receiving total arch replacements were excluded.
• Operative details, clinical outcomes, and survival were analyzed, comparing groups to a matched census cohort. Follow-up totaled 795.5 patient-years.

Main Results:

• Hospital mortality rates were identical (12.3%) in both groups.
• Actuarial survival estimates at 1, 5, and 10 years were similar between groups (e.g., 10-year survival: 55% Group A vs. 65% Group B).
• Proximal aortic reoperation was required in 4 patients in Group A versus none in Group B (P=0.085).

Conclusions:

• A strategy of aortic root replacement, rather than repair, for specific indications in type A dissection yields high survival and low proximal reoperation rates.
• These findings support an aggressive policy of composite aortic root replacement in acute type A dissection.