Short- and mid-term outcomes of the aortic root repair versus root replacement in acute type A aortic dissection

In patients with acute acute type A aortic dissection (ATAAD) requiring emergency surgery, the use of aortic root repair or replacement remains a topic of controversy. The purpose of this study was to evaluate the early and mid-term clinical outcomes after aortic root repair or replacement, and to provide a theoretical basis for such patients.

The study included 442 consecutive patients with ATAAD who underwent aortic root repair [n=227, repair group (RG)] or the Bentall procedure [n=215, Bentall group (BG)] at our hospital between December 2018 and December 2021. The indications for aortic root replacement were aortic root sinus diameter of ≥4.5 cm, severe sinotubular junction involvement, unrepairable aortic valvulopathy, severe coronary ostium involvement, connective tissue disease, intimal tear at the aortic root, or dissection involving three aortic sinuses. The primary outcome was the survival rate and incidence of reoperation between the two groups.

The in-hospital and 30-day mortality rates in the RG and BG were 10.1% and 11.6%, respectively. The two groups had no significant difference (P=0.613). Multivariate logistic analysis showed that aortic root surgery did not influence the in-hospital or 30-day mortality rates. The mean follow-up time was 36.8±11.6 months (median, 33.4 months; interquartile range, 27.0-45.2 months). The 5-year survival rates for the RG and BG were 88.1% and 85.9%, respectively (P=0.650). During the follow-up period, only one patient in the BG group underwent proximal aortic reoperation.

Continuous improvement of aortic root repair technology and identification of its indications may help reduce reoperation rates. Aortic root repair can be considered safe and feasible.