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

TL;DR

This study compares two surgical techniques for treating acute aortic dissection and finds that valve reimplantation has better outcomes than the Bentall procedure.

Contribution

The study demonstrates that modified aortic valve reimplantation is a viable alternative with favorable outcomes in acute type A aortic dissection.

Findings

Hospital mortality was lower in the reimplantation group (8.3%) compared to the Bentall group (22.9%).

Long-term survival rates were similar between the two groups.

Aortic regurgitation remained stable in all reimplantation cases.

Abstract

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.

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

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.

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.

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

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