Modified Aortic Valve Reimplantation in Patients with Acute Type A Aortic Dissection.

INTRODUCTION

Choosing a surgical technique in patients with acute type A aortic dissection is still a debatable issue. In patients with massive aortic root destruction, the Bentall procedure is a gold standard. Aortic valve reimplantation is a reliable alternative, especially in patients with the preserved anatomy of aortic valve leaflets.

OBJECTIVE

To compare the results of modified valve sparing procedure and composite root replacement in patients with acute type A aortic dissection.

METHODS

In total, 62 patients were included in this study. Of those, 27 patients underwent aortic valve reimplantation, and 35 had the Bentall procedure with the Kouchoukos modification.

RESULTS

Preoperative demographics and clinical characteristics were analyzed in both groups. Similar indicators of preoperative malperfusion were observed in both. Cardiopulmonary bypass time (P = 0.125) and aortic clamping time (P = 0.001) were longer (≈ 30 minutes) in the reimplantation group while the time of circulatory arrest was longer in the Bentall group (P = 0.290). Hospital mortality rates were 8.3% in the reimplantation group and 22.9% in the Bentall group. During the long-term follow-up period, there were six (25%) deaths in the reimplantation group and 10 (28.6%) deaths in the Bentall group. The aortic regurgitation degree was stable in all cases up to the moment of last contact with the patients.

CONCLUSION

Modified aortic valve reimplantation shows good immediate and long-term outcomes in patients with acute type A aortic dissection.