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

To evaluate long-term outcomes after root preservation and identify the root diameter warranting concomitant replacement during acute type A aortic dissection (ATAAD) repair.

Between January 2010 and December 2023, 681 patients with ATAAD underwent surgical repair. After excluding bicuspid aortic valve and connective tissue disorders, 42 patients underwent aortic root replacement or repair and 594 patients underwent ascending or total arch replacement with preservation of the native root. The patients were divided into 3 groups according to the aortic root diameter: <45 mm (group A; 535 patients), ≥45 and <50 mm (group B; 41 patients), and ≥50 mm (group C; 18 patients).

No significant differences in perioperative outcomes, specifically in-hospital mortality and stroke, were observed among the 3 study groups. The actual survival rates at 5 years and 10 years were 76.6% and 66.4% in group A, 79.2% and 66.0% in group B, and 94.1% and 44.1% in group C (log-rankP = .86). The rates of freedom from proximal aortic reoperation at 5 years and 10 years were 98.0% and 93.2% in group A, 92.3% and 92.3% in group B, and 72.0% and 28.0% in group C (log-rank P < .0001).

During surgery for ATAAD, an aortic root with a diameter ≥50 mm should be replaced, given significantly higher 5- and 10-year proximal aortic reoperation rates. In patients with aortic root diameters <50 mm, even if ≥45 mm, the aortic root may be preserved.