Root Management Strategy in Stanford A Aortic Dissection

Dongjin Wang, Albert Y. Xue, Qing Zhou, Hailong Cao, Jun Pan, Qiang Wang, Fudong Fan, Xiyu Zhu

Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: We retrospective observed the results of different surgical methods for TAAD patients and analyzed the risk factors of aortic insufficiency (AI) and aortic dilation in the midterm follow-up period.

Methods: The clinic data of 351 acute Stanford A aortic dissection patients received surgical therapy from January 2008 to December 2015 were analyzed retrospectively. There were 272 male and 79 female patients, aging from 22 to 83 years with a mean age of (52±13) years. According to root size, aortic valve structure and the status of dissection involvement, these patients were devided into three major groups: 218 cases with root reconstruction using Dacron felts, 34 cases with root reconstruction concomitant with aortic valve resuspension repair and 99 cases in with Bentall procedure. Proper shape based on the status of dissection involvement of Dacron patch was cut and put between the middle and outerlayer of aorta, then inside the inner layerone band Dacron felt was sutured with the aorta and the new middle layer with Dacron patch as mentioned above. In some cases the prolapsed aortic valve were re-suspended to the aortic cusp. Clinical outcomes among the 3 procedures were compared by χ2 test and analysis of variance.

Results: Cross-clamp, cardiopulmonary bypass, and circulatory arrest times of all the patients were (250±78), (171±70) and (31±10) minutes, respectively. The 30-day mortality was 9.2% (33/351), while no difference among the 3 procedures (9.6%, 8.8% and 9.1%). In the average follow-up time of (26±23) months (range from 0.5 to 90.0 months), survival rates were similar among the 3 procedures (77.7%, 77.4% and 77.8%). Only one patient received redo Bentall procedure because of severe aortic regurgitation and dilated aortic root (50 mm).

Conclusions: The indication of root management of acute Stanford A aortic dissection is based on the diameter of aortic root, structure of aortic leaflets, and the dissection involvement. For most acute Stanford A aortic dissection patients, aortic root reconstruction is a feasible and safe method.