Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection

Background. The aim of this study was to determine the durability of aortic valve preservation and root reconstruction in type A aortic dissection wit h involvement of the aortic root. Methods. From November 1976 to February 1999, 246 patients underwent surgic al treatment for acute type A aortic dissection at our institution. In 121 patients (49%), all with acute type A dissection and aortic root involvemen t, the aortic valve was preserved and one or more of the sinuses of Valsalv a were reconstructed. The mean age of this group was 59 +/- 11 years and 70 (58%) were men. Thirty patients (25%) were operated in cardiogenic shock. Criteria for aortic root reconstruction were technical feasibility and surg eon preference. Techniques used for reconstruction were valve resuspension in all patients and additional reinforcement of the aortic root with Teflon (L.R. Bard, Tempe, AZ) felt (n = 21), gelatin-resorcinol-formaldehyde-glue (GRF-glue, Fii, Saint-Just-Malmont, France) (n = 103), or fibrinous glue ( Tissu-col, Immune AG, Vienna, Austria) (n = 5). Mean follow-up was 43.5 +/- 46 months. Results. The operative mortality was 21.5% (n = 26). Actuarial survival was 72% +/- 4%, 64% +/- 5%, and 53% +/- 6% at 1, 5, and 10 years, respectively . Median aortic regurgitation in patients with retained native aortic valve at follow-up was 1+. All root reoperations included aortic valve replaceme nt (n = 12). Freedom from aortic root reoperation was 95% +/- 2% at 1 year, 89% +/- 4% at 5 years, and 69% +/- 9% at 10 years. The incidence of aortic root reoperation was 23%, 11%, and 40%, respectively, when Teflon felt, GR F-glue, and fibrinous glue were used for root reconstruction. Multivariate Cox proportional hazard analysis revealed the use of fibrinous glue (RR = 8 .7; p = 0.03) as well as the presence of an aortic valve annulus more than 27 mm (RR = 4.2; p = 0.04) as independent risk factors for aortic root reop eration. Conclusions. Aortic valve preservation in acute type A dissection provides relatively durable results. The use of fibrinous glue for root reconstructi on seems to compromise the long-term durability of the repair compared with Teflon felt and CRF-glue. A dilated aortic annulus requires a more extensi ve root procedure. (C) 2000 by The Society of Thoracic Surgeons.