Aortic Root Reconstruction With Pledgeted Sutures in Patients With Acute Type A Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Acute type A aortic dissection (ATAD) invariably involves the aortic root.
• Surgical management of ATAD requires addressing aortic root involvement.
• Traditional methods may involve aortic root replacement or adjuncts like surgical glue.

Purpose of the Study:

• To evaluate the early and late outcomes of aortic root reconstruction using pledgeted sutures in patients with ATAD.
• To assess the safety and efficacy of this technique over a 2-decade period.
• To determine the rate of adverse aortic root events and reoperations.

Main Methods:

• Retrospective review of open ATAD repairs from January 1999 to December 2024.
• Inclusion of patients who underwent supracoronary aortic repair with aortic root reconstruction.
• Exclusion of patients who underwent aortic root replacement.
• Definition and evaluation of adverse aortic root events.

Main Results:

• 758 patients underwent aortic root reconstruction; 14.1% operative mortality.
• 5-year overall survival was 72.2%; 10-year survival was 56.5%.
• Freedom from proximal reoperation was 96.0% at 5 years and 88.4% at 10 years.
• Freedom from adverse aortic root events was 93.2% at 5 years and 81.1% at 10 years.

Conclusions:

• Aortic root reconstruction with pledgeted sutures offers reasonable early and late outcomes in ATAD.
• This technique is suitable for patients with moderately dilated aortic roots.
• Pledgeted sutures provide an effective alternative to surgical glue for aortic root repair in ATAD.