Valve-Sparing Versus Composite Graft Aortic Root Replacement in Acute Type A Aortic Dissection with Standardized...

The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic dissection (ATAAD) in a propensity score matching analysis.

In this retrospective study we compared the outcomes before and after propensity score matching of patients who underwent emergency surgical repair for ATAAD requiring replacement of the aortic hemiarch with replacement of the aortic root between 2001 and 2023 at our institute. The 154 patients were divided into two groups: the first group consisted of patients undergoing David (n = 59), and the second group of patients undergoing Bentall (n = 95) procedures combined with an aortic hemiarch replacement. To reduce the confounding impact of pre-operative variables in this non-randomized study, 1:1 propensity score matching using the Nearest-Neighbour Matching algorithm was used.

Patients in the David plus Hemiarch group were significantly younger (62.16 ± 12.35 vs. 55.55 ± 10.80, p = 0.001). After the propensity score matching there were no significant differences between the two groups regarding intra-operative variables and hospital outcomes. In-hospital death was 15% (n = 6) in the David plus Hemiarch group compared to 24% (n = 10) in the Bentall plus Hemiarch group (15% vs. 24%, p = 0.40). Operation time was also similar between the two groups, being 402 and 384 min, respectively. Survival analyses also did not show any difference in long-term survival between both groups.

When a standardized hemiarch replacement was used, no significant differences in short- and long-term outcomes were observed between a valve-sparing procedure and composite graft replacement in patients undergoing surgical repair for ATAAD. Surgeons should opt for the surgical strategy they are most comfortable with. This study represents one of the few analyses comparing the David and Bentall techniques in ATAAD patients undergoing standardized hemiarch replacement. Despite its retrospective nature, it provides clinically relevant insights for surgical decision-making in emergency settings.