Aortic valve preservation in acute type A dissection: Mid-term results

Background and aim of the study: The study aim was to evaluate the long-ter m effectiveness of a strategy for managing the aortic valve, aortic root an d ascending aorta according to the pathology in acute aortic type A dissect ion. Results after surgery for acute type A dissection with preservation of the aortic valve were reviewed. Methods: The patient group included 57 hospital survivors operated on accor ding to a surgical strategy of aortic valve resuspension and supracoronary ascending aortic graft implantation. Reinforcement of the aortic stumps wit h gelatin-resorcinol-formaldehyde glue was performed in all patients. Aorti c valve function in all survivors was investigated by echocardiographic fol low up at 30 days, 6 and 12 months after surgery, and yearly thereafter. Results: During the follow up period, nine patients (16%) died without reop eration. Actuarial probability of freedom from reoperation for aortic valve failure in the complete series was estimated as 100% after both 30 days an d 12 months. Postoperatively, one patient underwent reoperation 14 months f or aortic regurgitation, and three patients for aortic regurgitation with s inus of Valsalva dilatation between 48 and 88 months. The hospital mortalit y rate at reoperation was 50% (n = 2). Conclusion: Valve-sparing surgery is possible and can be recommended for th e majority of patients with acute type A aortic dissection.