Composite aortic root replacement in African patients with type A aortic dissection: report of 12 cases

Type A aortic dissection (TAAD) is associated with high mortality in the absence of appropriate surgical therapy. The involvement of the aortic root by the intimal tear and the presence of severe aortic insufficiency will require a more radical approach with composite root replacement (CRR) in most of the patients. We briefly report our surgical experience following CRR in 12 patients presenting with TAAD in our department. Between November 2009 and January 2022, a total of twelve (n=12) patients diagnosed with TAAD were operated in our institution. Clinical data and surgical outcomes were retrospectively reviewed. The mean age at admission was 51.1 ± 12.43 years (range: 34-72). One patient met the criteria for Marfan´s disease (1/12, 8.3%). The operative mortality was 16.66% (2/12). Composite root replacement with a mechanical valved conduit was performed in the majority (11/12, 91.66%;) whereas a separated supracoronary graft replacement and aortic valve replacement were performed in one patient. Concomitant aortic arch surgery (hemi or total) was done in 9/12 patients (75%). The commonest postoperative complications were: chest re-exploration for bleeding in 2/12 (16.66%), transitory cerebral ischemia in 1/12 (8.33%) and low cardiac output syndrome in 2/12 (16.66%). The mean length of stay in the Intensive Care Unit (ICU) was 4.8±3.8 days (range: 2-17). Delayed referral of patients with TAAD was observed in the majority of patients as they were operated in the subacute or chronic phase. Composite root replacement in these patients is associated with acceptable outcomes despite complex anatomic-pathological lesions.