Proximal aortic dissection late after aortic valve surgery: 119 cases of adistinct clinical entity

Background: Besides systemic hypertension and Marfan syndrome, only previou s aortic valve replacement (AVR) is independently associated with proximal (type A) aortic dissection. Little, however, is known to date about the cha racteristic features of this clinical entity. Methods: Clinical, prognostic and predisposing profiles in 119 cases of dissection and/or aneurysm occur ing 1 month to 16 years after routine AVR were analyzed comprising 62 cases from our database and 57 reported cases. Results: Dissection after AVR has been observed in 0.6% of all routine AVR procedures in the past four decad es. With clinical signs, symptoms and anatomical features different from cl assic aortic dissection post-AVR dissection is a distinct clinical entity w ith a high intraoperative mortality of 44% and a 30-day and 5-year survival of 62% and 43%, respectively. Aortic regurgitation and a thin and/or fragi le aortic wall at AVR, however, predict late dissection. Using a prediction model, the risk of late dissection can be stratified based on information obtained during AVR surgery. Conclusions: Aortic dissection following AVR i s likely to represent a distinct clinical entity which can be predicted and possibly prevented at AVR.