[Efficacy of selective sinus replacement for acute Stanford type A aortic dissection]

Objective: To investigate the efficacy of selective sinus replacement (SSR) in the treatment of acute Stanford type A aortic dissection. Methods: A retrospective analysis was conducted on patients who underwent selective aortic sinus replacement or aortic root replacement for aortic sinus involvement. These patients were among 310 emergency cases of Stanford type A aortic dissection admitted to the Division of Cardiovascular Surgery of the University of Hong Kong-Shenzhen Hospital between July 1, 2020, and December 31, 2024. Based on the surgical procedure performed on the aortic root, the patients were divided into three groups: the David group, the SSR group, and the bioprosthetic Bentall (Bio-Bentall) group. The operative time, intraoperative blood loss, cardiopulmonary bypass time, aortic cross-clamp time, postoperative hospital stay, complications, and follow-up outcomes including aortic valve function and changes in aortic root diameter were compared among the different surgical groups. Results: A total of 42 patients (34 males and 8 females) aged (48±21) years were included, with 11, 20 and 11 cases in the David group, the SSR group and the Bio-Bentall group, respectively. All surgeries were successfully completed without perioperative mortality or major cardiovascular events. The SSR group demonstrated shorter aortic cross-clamp time [(138±29) min vs (166±19) min], cardiopulmonary bypass time [(201±43) min vs (219±23) min], and operative time [(423±60) min vs (448±58) min] compared with the David group (both P<0.05). No statistically significant differences were observed in 30-day postoperative complications or long-term follow-up outcomes among the SSR, David, and Bio-Bentall groups (all P>0.05). During follow-up, all patients exhibited well aortic valve function, with no moderate or severe aortic regurgitation. In the SSR group, the aortic sinus diameter significantly decreased at 6 months postoperatively compared with the preoperative measurement [(36±3) mm vs (40±5) mm, P=0.032]. No statistically significant difference was observed between the measurements at 6 months and 1 year postoperatively [(36±3) mm vs (35±3) mm, P=0.522]. Conclusion: SSR represents a safe and effective surgical strategy for acute Stanford type A aortic dissection in carefully selected patients.