Study Design
All patients admitted to the Royal Brompton and Harefield NHS Foundation
Trust between January 2009 and December 2018 with ATAAD and who
underwent emergency surgery were identified for inclusion in this study.
Perioperative data was prospectively collated with adherence to national
guidelines for cardiothoracic surgery data reporting including data
collection on baseline demographics, operative variables and short-term
outcomes [7]. Long term mortality was assessed using the NHS Spine
database [8]. The requirement for ethical approval was waived by the
Research Ethics Office at Royal Brompton and Harefield NHS Foundation
Trust due to the retrospective nature of the study.
Patients included in this study were divided into two cohorts determined
by whether the native aortic root (including valve) was replaced or
preserved at the time of emergency surgery. In the first cohort,
patients undergoing aortic root replacement (ARR) had either a composite
valve-graft replacement (Bentall’s procedure) or porcine valve-graft
replacement (Freestyle procedure). In the second cohort, patients
underwent an asacending aorta interposition graft (AAG) with
preservation of the aortic root and resuspension of the native aortic
valve. No patients in this institution underwent valve-sparing root
replacement (e.g. David/Yacoub procedures) for ATAAD. To ensure
homogeneity of the cohort, all patients undergoing replacement of the
arch (e.g. total arch replacement, frozen elephant trunk) were excluded
from the study.