Does the extent of proximal or distal resection influence outcome for typeA dissections?

Background. The extent of proximal and distal aortic resection that should be performed for acute type A aortic dissections remains controversial. Methods. From 1984 to 1999, 119 patients underwent repair of an acute type A dissection. Distal resection was to the ascending aorta in 78 (66%) and h emiarch in 41 (34%) patients. Proximally, the aortic valve was preserved in 69 (58%) patients, 40 (34%) underwent composite valve grafting, and 10 (8% ) underwent separate graft and valve replacement. Results. Operative mortality was higher for separate graft and valve (50% /- 16%) than for valve preservation (16% +/- 5%) or composite grafts (20% /- 7%) (p < 0.05). Hemiarch replacement did not increase operative risk com pared to distal reconstruction to the ascending aorta (17% +/- 6% versus 22 % +/- 5%, p > 0.71). At 10 years, freedom from reoperation was 81% +/- 7% a nd long-term survival was 60% +/- 8%, but neither was related to the proxim al or distal surgical technique (p > 0.15). Risk factors for late reoperati on included a nonresected primary tear and Marfan syndrome (p < 0.05). Conclusions. An aggressive surgical approach, including a full root or hemi arch replacement, is not associated with increased operative risk and shoul d be considered when type A dissections extensively involve the valve, sinu ses, or arch. (C) 2001 by The Society of Thoracic Surgeons.