Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Research

Background:

• The long-term durability of aortic root repair versus replacement in acute type A aortic dissection remains incompletely understood, particularly concerning aortic insufficiency and sinus of Valsalva stability.
• Assessing clinical and functional outcomes is crucial for optimizing surgical strategies in this critical patient population.

Purpose of the Study:

• To compare the clinical and functional outcomes of aortic root repair versus root replacement in patients undergoing surgery for acute type A aortic dissection.
• To evaluate the impact of each surgical approach on survival, reoperation rates, aortic insufficiency, and the stability of the sinuses of Valsalva.

Main Methods:

• A retrospective analysis of 716 patients with acute type A aortic dissection who underwent either root repair (n=585) or root replacement (n=131).
• Comparison of survival, cumulative incidence of reoperation, aortic insufficiency severity, and sinus of Valsalva dimensions between the two groups.
• Statistical analysis included multivariable Cox regression and mixed-effects models to identify risk factors and assess longitudinal outcomes.

Main Results:

• Survival rates at 1, 5, and 10 years were comparable between root repair and replacement groups (P=.69).
• The cumulative incidence of reoperation was significantly lower in the root repair group compared to the root replacement group at 10 years (P=.011).
• Root replacement was associated with reduced sinus of Valsalva dilation (P<.001) and lower severity of postoperative aortic insufficiency (P<.001).

Conclusions:

• While survival is similar, aortic root repair for acute type A aortic dissection is associated with a higher incidence of aortic insufficiency and root dilation compared to root replacement.
• Root replacement demonstrates superior long-term stability of the sinuses of Valsalva and better control of aortic insufficiency.