Ma. Ergin et al., RADICAL REPLACEMENT OF THE AORTIC ROOT IN ACUTE TYPE-A DISSECTION - INDICATIONS AND OUTCOME, European journal of cardio-thoracic surgery, 10(10), 1996, pp. 840-844
Objective. Failure of the repair at the proximal aorta is an important
cause of morbidity and mortality following surgical treatment of acut
e type A dissection. This review was undertaken to determine the influ
ence of total composite replacement of the ascending aorta and the roo
t on the operative risk and longterm survival. Methods. In a consecuti
ve series of 73 patients With acute type A dissections between 1985 an
d 1994, 19 (26%) patients with radical root replacement (group Ij were
compared with 54 patients who had conventional valve-preserving root
reconstruction (group II). Results. Group I represented a higher opera
tive risk with the presence of significant aortic regurgitation (13/19
68.4% vs 23/54 42.5% P<0.05), aortic dilatation (19/19 100% vs 32/54
59.2% P<0.00), and coronary dissection (13/19 68.4% vs 3/54 5.5% P<0.0
00). In spite of this there was no difference in operative mortality (
3/19 15.7% vs 7/54 12.9%, NS) or the occurrence of major postoperative
complications: bleeding (3/19 15.7% vs 7/54 12.9%, NS), respiratory (
5/19 26.3% vs 11/54 20.3%, NS), stroke (2/19 10.5% vs 3/54 5.5%, NS).
Patients with radical root replacement had substantially better event-
free survival at 5 years (87.5%+/-11.7% vs 67.1%+/-8.9%) and 9 years (
87.5%+/-21.9% vs 63.0%+/-19.2%). Conclusions. This experience confirms
that, in the treatment of acute type A dissection, an aggressive appr
oach to aortic root pathology is indicated for specific indications, a
nd can be carried out with good early and excellent long-term results.