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Comparison of outcomes between aortic root replacement and supra-coronary interposition graft for type A aortic dissection: A Retrospective Case Series
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  • Philip Hartley,
  • Yousuf Salmasi,
  • Marco Morosin,
  • Kwabena Mensah,
  • GEORGE ASIMAKOPOULOS
Philip Hartley
Royal Brompton and Harefield Hospitals

Corresponding Author:philhar89@gmail.com

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Yousuf Salmasi
Royal Brompton and Harefield Hospitals
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Marco Morosin
Royal Brompton and Harefield Hospitals
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Kwabena Mensah
Royal Brompton and Harefield Hospitals
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GEORGE ASIMAKOPOULOS
Royal Brompton and Harefield Hospitals
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Abstract

Background The decision to conserve or replace the native aortic valve following acute type-A aortic dissection (ATAAD) is an area of cardiac surgery without standardised practice. This single centre retrospective study analysed the long-term performance of the native aortic valve and root following surgery for ATAAD. Methods Between 2009 and 2018 all cases ATAAD treated at Royal Brompton and Harefield NHS Foundation Trust were analysed. Patients were divided into 2 groups: a) ascending aorta (interposition) graft (AAG) without valve replacement; and b) non-valve-sparing aortic root replacement (ARR). Pre-operative covariates were compared, as well as operative characteristics and post-operative complications. Long-term survival and echocardiographic outcomes were analysed using regression analysis. Results In total, 116 patients were included: 63 patients in the AAG group and 53 patients in the ARR group. In patients where the native aortic valve was conserved, 9 developed severe aortic regurgitation and 2 patients developed dilation of the aortic root requiring subsequent replacement during the follow-up period. Aortic regurgitation at presentation was not found to be associated with subsequent risk of developing severe aortic regurgitation or reintervention on the aortic valve. Overall mortality was observed to be significantly lower in patients undergoing AAG (17.5% vs. 41.5%, p=0.004). Conclusions With careful patient selection, the native aortic root shows good long-term durability both in terms of valve competence and stable root dimensions after surgery for ATAAD. This study supports the consideration of conservation of the aortic valve during emergency surgery for type-A dissection, in the absence of a definitive indication for root replacement, including in cases where aortic regurgitation complicates the presentation.
23 May 2022Submitted to Journal of Cardiac Surgery
23 May 2022Submission Checks Completed
23 May 2022Assigned to Editor
24 May 2022Reviewer(s) Assigned
17 Jul 2022Review(s) Completed, Editorial Evaluation Pending
17 Jul 2022Editorial Decision: Revise Major
11 Aug 20221st Revision Received
02 Sep 2022Submission Checks Completed
02 Sep 2022Assigned to Editor
02 Sep 2022Reviewer(s) Assigned
02 Sep 2022Review(s) Completed, Editorial Evaluation Pending
03 Sep 2022Editorial Decision: Accept