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Updated: Oct 3, 2025
14:14
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
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Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection.
Mikko Jormalainen1, Risto Kesävuori2, Peter Raivio1
1Division of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Interactive Cardiovascular and Thoracic Surgery
|February 21, 2022
Summary
Supracoronary ascending aorta replacement offers similar long-term survival and reoperation rates compared to aortic root replacement for acute Stanford type A aortic dissection (TAAD). Both surgical approaches provide comparable clinical outcomes when stringent selection criteria are applied.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Dissection Research
Background:
- Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition requiring prompt surgical intervention.
- Surgical strategies for TAAD often involve either ascending aortic replacement or aortic root replacement, with ongoing debate regarding optimal late outcomes.
Purpose of the Study:
- To compare the late clinical outcomes, specifically mortality and need for reoperation, between supracoronary ascending aorta replacement and aortic root replacement in patients with acute TAAD.
- To evaluate the efficacy of selective surgical strategies for proximal aortic reconstruction in TAAD.
Main Methods:
- A retrospective analysis of 309 patients who underwent surgery for acute TAAD between 2005 and 2018 at Helsinki University Hospital.
- Kaplan-Meier method for late mortality and competing risk method for proximal aortic reoperation were employed.
- Propensity score matching was used to compare outcomes between the two surgical groups.
Main Results:
- At 10 years, no significant difference in mortality was observed between aortic root replacement (33.8%) and ascending aortic replacement (35.2%) (P=0.806).
- Cumulative incidence of proximal aortic reoperation was similar, with 6.0% for aortic root replacement and 6.2% for ascending aortic replacement (P=0.65).
- In propensity score matched pairs, 10-year survival was comparable (34.4% vs. 36.2%, P=0.70), though reoperation rates showed a trend (7.0% vs. 13.0%, P=0.22).
Conclusions:
- Selective use of supracoronary ascending aorta replacement achieves late clinical outcomes comparable to aortic root replacement for acute TAAD.
- Stringent selection criteria for proximal aortic reconstruction are crucial for achieving similar outcomes between the two surgical approaches.
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