Valve sparing aortic root reconstruction in acute dissection of the ascending aorta

Abstract

Objectives: Acute dissection of the ascending aorta requires immediate surgical intervention. Use of the re-implantation technique in patients with severe aortic insufficiency remains controversial. In this study we assessed the feasibility and outcome of the valve-sparing aortic root re-implantation technique in patients with severe preoperative aortic insufficiency. Methodology: Between April 2005 and March 2008, 19 patients with acute aortic dissection of the ascending aorta (Stanford type A) underwent valve sparing aortic root reconstruction. Their ages ranged from 24 to 76 years (51.7 +/- 13.2, 58% males). Transesophageal echocardiography was carried out for diagnosis of disease, left ventricle ejection fraction and valve insufficiency. Length of hospitalization, echocardiographic and clinical follow-up, complications and mortality were analyzed. Results: Four patients (21%) died of non-valve-related complications. Major complications after operation were seen in three patients (15.8%). Mean length of stay in the intensive care unit (ICU) was nine days, and the mean duration of hospitalization were 16 days. Comparison of pre- operative and post-operative clinical profiles of patients showed that left ventricle ejection fraction and severity of aortic insufficiency were significantly altered (P < 0.05). Comparison of patients who survived with those who died showed that only cardio pulmonary bypass time had statistically significant difference (P=0.04). Conclusion: Valve sparing aortic root reconstruction in patients with type A dissection can be performed with acceptable intra-operative mortality and morbidity and excellent results during follow-up.