Long-Term Results of Valve Sparing Aortic Root Replacement in Acute Type A Aortic Dissection

Bradley G Leshnower; Woodrow J Farrington; Lauren V Huckaby; William B Keeling; Alysa B Zellner; Edward P Chen

doi:10.1016/j.athoracsur.2024.09.007

Long-Term Results of Valve Sparing Aortic Root Replacement in Acute Type A Aortic Dissection

Ann Thorac Surg. 2024 Sep 16:S0003-4975(24)00772-0. doi: 10.1016/j.athoracsur.2024.09.007. Online ahead of print.

Authors

Bradley G Leshnower¹, Woodrow J Farrington², Lauren V Huckaby², William B Keeling², Alysa B Zellner², Edward P Chen³

Affiliations

¹ Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address: bleshno@emory.edu.
² Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA.
³ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, NC.

PMID: 39293750
DOI: 10.1016/j.athoracsur.2024.09.007

Abstract

Background: Valve preservation in acute type A aortic dissection (ATAAD) can be accomplished with root repair or replacement. Long-term valve durability with root repair has been established, but limited data exists regarding long-term durability of valve sparing root replacement (VSRR). This study compared long-term results of VSRR to root repair in ATAAD.

Methods: From 2005-2023, 866 patients underwent ATAAD repair, of which 675 underwent root repair and 191 underwent root replacement (VSRR = 65, Bentall = 126). VSRR patients were compared to 123 patients who underwent valve resuspension and root repair (Root Repair) with postoperative echocardiograms ≥ 1 year.

Results: VSRR patients were younger (VSRR 44±11 vs. Root Repair 55±13 years, p<0.001). Preoperatively, 57% of VSRR and 35% of Root Repair patients had ≥ moderate aortic insufficiency. Cardiopulmonary bypass and, myocardial ischemia times were significantly longer in VSRR (p<0.001). Postoperative echocardiograms with ≥ 1 year follow-up were analyzed in 58 VSRR patients with median follow-up of 4.8 [IQR 3,12] years and in 123 Root Repair patients with median follow-up of 3.6 [IQR 3, 8] years. At 10 years, VSRR patients had superior freedom from > mild aortic insufficiency (VSRR 91% vs. Root Repair 49%, p <0.001). At 10 years, freedom from aortic valve replacement was equivalent (VSRR 98% vs. Root Repair 92%, p=0.269).

Conclusions: VSRR provides equivalent long-term valve durability as root repair in ATAAD, even in patients with moderate or severe aortic insufficiency. In select young patients who require root replacement during ATAAD repair, VSRR represents an ideal therapy.