Fate of the aortic valve after root reconstruction in type A aortic dissection: a 20-year follow up.

ABSTRACT

BACKGROUND AND AIM OF THE STUDY The study aim was to evaluate the fate of the aortic valve after root reconstruction in acute type A aortic dissection. METHODS: Between 1982 and 2006, a total of 373 consecutive patients underwent emergency surgery for acute type A aortic dissection at the authors' institution. Of these patients, 298 (mean age 63 +/- 11 years; range 22-85 years) underwent replacement of the supracoronary aorta with root reconstruction. The mean follow up period was 6.9 +/- 5.2 years (range 2 months to 23 years), and was 98% complete. Aortic valve function was assessed by the incidence of aortic valve reoperation and transthoracic echocardiography. RESULTS: The 30-day mortality was 27% (82/298). Survival was 80%, 57% and 49% at five, 10 and 15 years, respectively. For survivors at the latest follow up, freedom from moderate or severe aortic regurgitation (AR) was 93%, 84% and 72% at five, 10 and 15 years, respectively. Four patients had severe AR but were not reoperated on. Among 200 patients discharged, 13 (6.5%) were reoperated on for severe AR, with an operative mortality of 15% (n = 2). Freedom from aortic valve replacement was 97%, 92% and 84% at five, 10 and 15 years, respectively. Cox regression analysis identified age < or = 59 years (p = 0.0201) and 'low-volume surgeon' (p = 0.0004) as risk factors for recurrent moderate or severe AR. CONCLUSION: The study results showed that, when the aortic dissection involves the aortic root, supracoronary replacement of the ascending aorta with a root reconstruction allows preservation of the aortic valve in the majority of patients, with a satisfactory long-term outcome.