Determining the aortic root diameter necessitating replacement during acute type A aortic dissection repair.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection Research

Background:

• Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring prompt surgical intervention.
• Management of the aortic root during ATAAD repair is crucial for long-term outcomes.
• Current guidelines vary on the threshold for aortic root replacement versus preservation.

Purpose of the Study:

• To evaluate long-term outcomes following aortic root preservation in ATAAD repair.
• To identify the specific aortic root diameter that necessitates concomitant replacement during ATAAD surgery.

Main Methods:

• Retrospective analysis of 681 ATAAD patients from January 2010 to December 2023.
• Exclusion of patients with bicuspid aortic valve and connective tissue disorders.
• Categorization into three groups based on aortic root diameter: <45 mm, ≥45 to <50 mm, and ≥50 mm.

Main Results:

• No significant differences in perioperative mortality or stroke were observed across groups.
• Long-term survival rates were comparable between groups with preserved roots (<50 mm) and replaced roots (≥50 mm).
• Freedom from proximal aortic reoperation was significantly lower in the ≥50 mm group (72.0% at 5 years, 28.0% at 10 years) compared to smaller diameters.

Conclusions:

• Aortic root diameter ≥50 mm is associated with significantly higher rates of proximal aortic reoperation, warranting replacement during ATAAD repair.
• Aortic roots <50 mm, including those ≥45 mm, can be safely preserved with favorable long-term outcomes.
• Preservation of the native aortic root in ATAAD repair is feasible and effective for diameters less than 50 mm.