Supracoronary ascending aortic replacement in patients with acute aortic dissection type A: what happens to the aortic root in the long run?

OBJECTIVE: Our objective was to determine long-term outcome predictors for patients with acute aortic dissection type A (AADA) and aortic root involvement.

METHODS: From 2001 through 2009, 119 of 152 patients operated on for AADA at a tertiary medical center underwent supracoronary ascending aortic replacement (52 women; mean age, 61 ± 15 years). Those with at least 1-year follow-up (n = 97) were retrospectively assessed for preoperative aortic root disease. Follow-up data were assessed for evidence of new-onset aortic root disease by computed tomography and echocardiography, and for reoperation for aortic root disease.

RESULTS: Median follow-up was 33.8 months (range, 0-112 months). Twenty-six (27%) patients had new-onset aortic root disease at 4.4 ± 2.6 years after the initial procedure (range, 1.0-8.2 years) and 10 required aortic root reoperation. Severe aortic dissection with extension to pelvic arteries was an independent predictor for new-onset aortic root disease (P < .01). Dissection of all aortic sinuses during the initial procedure was an independent predictor (P < .05) for aortic root reoperation. Mean rate of aortic root expansion after supracoronary repair was 0.6 ± 1.1 mm per year. Preoperative aortic root diameter and aortic sinus dissection did not affect survivals. Five-year survivals were similar in patients with and without new-onset aortic root disease (91% vs 89%; P = .79).

CONCLUSIONS: In patients with AADA, dissection of 3 aortic sinuses is an independent predictor for need of reoperation, whereas dissection extension into the iliac arteries is a predictor of secondary aortic root disease. Long-term follow-up at close intervals is warranted in patients with supracoronary ascending aortic replacement to reduce mortality caused by new onset of aortic root disease.