Valve-sparing aortic root replacement (remodeling/reimplantation) in acutetype A dissection

Background. High reoperation rates after supracommissural tube graft replac ement for acute type A dissection due to sinus of Valsalva dilation have be en reported. Valve-sparing operations focusing on the replacement of the si nus of Valsalva are an appealing alternative. The applicability of these te chniques in acute type A dissection remains debatable and results are limit ed. Methods. From 1992 to 1998, 20 patients with acute type A dissection receiv ed a valve-sparing aortic root replacement. Two different types of aortic v alve-sparing operations were performed: the remodeling technique in 11 pati ents and the reimplantation technique in 9 patients. Patients were followed for 26 +/- 18 months. Echocardiographic studies were performed every 6 mon ths. Results. There were 2 early postoperative deaths and no late death, no reop eration, and no thromboembolic events. The latest echocardiographic studies of the 18 survivors showed a competent valve in 12 and a trivial aortic va lve insufficiency in 6 patients. The mean aortic valve pressure gradient wa s 4.3 +/- 1.3 mm Hg. Conclusions. These midterm results support the surgical strategy of valve-s paring aortic root replacement in patients with acute type A dissection. (A nn Thorac Surg 2000;70:21-4) (C) 2000 by The Society of Thoracic Surgeons.