The David Versus the Bentall Procedure for Acute Type A Aortic Dissection.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Type A aortic dissection (TAAD) is a critical condition necessitating rapid diagnosis and surgical intervention.
• When TAAD affects the aortic root, surgical options include aortic valve-sparing or Bentall procedures.

Purpose of the Study:

• To compare the outcomes of the Bentall procedure versus the David procedure for Type A aortic dissection involving the aortic root.
• To evaluate the durability and safety of these surgical techniques in a large patient cohort.

Main Methods:

• Analysis of 3735 patients from the European Registry of Type A Aortic Dissection (ERTAAD).
• Propensity score matching was used to create comparable groups for the Bentall and David procedures.
• Multilevel mixed-effects logistic regression considered hospital cluster effects.

Main Results:

• After propensity score matching (115 patients per group), no significant differences in postoperative outcomes were observed, except for a higher dialysis rate in the Bentall group.
• The David procedure showed a trend towards lower 10-year mortality in unmatched cohorts, but this difference disappeared after matching.
• No significant differences in proximal aortic reoperation rates were found between the two procedures at 10 years, even after matching.

Conclusions:

• Both the David and Bentall procedures are durable and effective surgical treatments for TAAD involving the aortic root.
• The David procedure is recommended for acute TAAD when technically feasible and performed by experienced surgeons due to its durability.