# To replace or not to replace the aortic valve during Type A Aortic Dissection surgery: early and mid-term results

## TL;DR

This study compares outcomes of replacing or not replacing the aortic valve during surgery for Type A Aortic Dissection, finding that not replacing the valve may lead to better results.

## Contribution

The study provides new insights into the comparative effectiveness of valve replacement versus non-replacement in Type A Aortic Dissection surgery.

## Key findings

- The valve replaced group had longer X-Clamp and CPB times and higher need for postoperative mechanical support.
- The not valve replaced group showed no moderate-to-severe aortic regurgitation recurrence or sinus valsalva aneurysm.
- The not valve replaced procedure was found to be superior based on intraoperative and postoperative outcomes.

## Abstract

The decision to replace or not to replace the aortic valve in the surgical treatment of Type A Aortic Dissection can be complicated in hesitant cases. It is controversial which procedure should be used in such cases and may significantly alter intraoperative/postoperative patient care and disease prognosis in an operation with a high mortality and morbidity rate, such as Type Aortic Dissection Surgery. In this study, we aim to compare the early and mid-term results of these two different methods.

Between February 2019 and September 2022, 112 consecutive patients examined who underwent operation for TYPE A AORTIC DISSECTION in our clinic, retrospectively. Patients were than divided into two groups: those who the valve replaced group (Modified Bentall Procedure, SGI + AVR), (n = 26, 23.2%), and those who had the not valve replaced group (Isolated SGI, David II procedure, AV Resuspension), (n = 86, 76.8%).

It was observed that the X-Clamp and CPB times were longer and the need for postoperative mechanical support was higher in the valve replaced group (p < 0.05). Although it was not statistically significant, the false lumen patency rate was higher and the survival time was lower in the valve replaced group. In the postoperative controls, moderate-to-severe aortic regurgitation was not seen in any of the patients who had preoperative moderate-to-severe aortic regurgitation in the not valve replaced group and there was no sinus valsalva aneurysm in any patient.

When the intraoperative and postoperative results in our study were evaluated, it was concluded that the not valve replaced was superior to the valve replaced procedures for TYPE A AORTIC DISSECTION patients.