Outcomes Of Partial Aortic Root Replacement Approach In Acute Type A Aortic Dissection With Intimal Tear Extending To The Aortic Sinuses
Shi S. Poon, Pankaj Kumar.
Morriston Hospital, Swansea, United Kingdom.
OBJECTIVE: Despite surgical advances in the treatment of type 'A' aortic dissection, the management of aortic root in the setting of dissection extending to the aortic sinuses remains controversial. The role of partial aortic root replacement approach in this challenging setting remain unclear. We present our experience of partial root replacement in cases of aortic dissection extending into the aortic root with complete resection of the dissected tissue and replacement of the dissected aortic root.
METHODS: A retrospective study of patients who underwent partial root replacement following acute type A aortic dissection. All patients have intimal tear in the aortic sinuses. Echocardiography study was performed during follow up to assess the aortic root dimension and valvular function.
RESULTS: 12 patients who required partial aortic root replacement were included in the study (mean age was 69). Follow up ranged from 1-6 years (mean=3 years). There were no in-hospital mortality and 3 late deaths all non-cardiac/non-aortic during follow up (2 pancreatic cancer,1 COPD exacerbation). The mean cardiopulmonary bypass time,cross-clamp time and circulatory arrest time were 126 mins,87 mins and 37 mins respectively. 2 patients required post-operative renal dialysis and one developed permanent stroke. Replacement of non-coronary sinus was necessary in all 12 patients and in addition the right coronary was replaced in 5 patients (5/12,41%) given intimal tear involvement in the aortic root. Follow up echocardiography scan revealed trivial/mild aortic regurgitation in 9 patients and moderate aortic regurgitation in 3 patients. All patients remained asymptomatic. (NYHA Class 1 CCS Class 0).
CONCLUSIONS: Partial aortic root replacement can be safely performed in acute type A dissecting involving the aortic sinuses. We believe it is vital to moblise the aortic root and resect all dissected tissues. Long term follow up is needed to determine the durability of partial aortic root replacement in this setting.
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