Radical replacement of the aortic root in acute type A dissection: Indications and outcome

Objective. Failure of the repair at the proximal aorta is an important cause of morbidity and mortality following surgical treatment of acute type A dissection. This review was undertaken to determine the influence of total composite replacement of the ascending aorta and the root on the operative risk and long-term survival. Methods. In a consecutive series of 73 patients with acute type A dissections between 1985 and 1994, 19 (26%) patients with radical root replacement (group I) were compared with 54 patients who had conventional valve-preserving root reconstruction (group II). Results. Group I represented a higher operative risk with the presence of significant aortic regurgitation (13/19 68.4% vs 23/54 42.5% P < 0.05), aortic dilatation (19/19 100% vs 32/54 59.2% P < 0.00), and coronary dissection (13/19 68.4% vs 3/54 5.5% P < 0.000). In spite of this there was no difference in operative mortality (3/19 15.7% vs 7/54 12.9%, NS) or the occurrence of major postoperative complications: bleeding (3/19 15.7% vs 7/54 12.9%, NS), respiratory (5/19 26.3% vs 11/54 20.3%, NS), stroke (2/19 10.5% vs 3/54 5.5%, NS). Patients with radical root replacement had substantially better event-free survival at 5 years (87.5% ± 11.7% vs 67.1% ± 8.9%) and 9 years (87.5% ± 21.9% vs 63.0% ± 19.2%). Conclusions. This experience confirms that, in the treatment of acute type A dissection, an aggressive approach to aortic root pathology is indicated for specific indications, and can be carried out with good early and excellent long-term results.