1. Outcomes of valve-sparing root replacement in acute Type A aortic dissection.
- Author
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Tanaka H, Ikeno Y, Abe N, Takahashi H, Inoue T, and Okita Y
- Subjects
- Adult, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Complications, Reoperation, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Aortic Valve surgery, Cardiovascular Surgical Procedures adverse effects, Cardiovascular Surgical Procedures methods, Cardiovascular Surgical Procedures mortality, Organ Sparing Treatments adverse effects, Organ Sparing Treatments methods, Organ Sparing Treatments mortality
- Abstract
Objectives: To investigate the long-term durability of aortic valves, we reviewed the outcomes of patients who underwent valve-sparing root replacement with acute Type A aortic dissection., Methods: We included patients who underwent emergent aortic repair for acute Type A aortic dissection at our university hospital between 2000 and 2016. We identified patients who underwent valve-sparing root replacement from the included cohort and assessed their survival and long-term valve durability., Results: We identified 24 of 328 patients who underwent valve-sparing root replacement (age: mean ± SD 49 ± 11 years; 17 men). All patients underwent reimplantation procedures and 2 had concomitant cusp repairs (central plication). Prolapsed cusps caused by detached commissures in 12 cases were noted and reattached with buttress sutures with or without glue. There was no in-hospital mortality. Median follow-up period was 84 months (range 1-202 months) and survival was 100% at 5 and 10 years. Freedom from moderate or greater aortic insufficiency was 82% ± 10% at 5 years and 65% ± 13% at 10 years. Freedom from aortic valve reoperation was 83% ± 9% at 5 years and 69% ± 12% at 10 years. Valve reoperations were indicated for endocarditis in 1 patient, perforation of the aortic cusp in 1 patient and redetachment of commissures that had been attached with gelatin-resorcinol-formaldehyde glue at the initial operations in 3 patients., Conclusions: The durability of valve-sparing root replacement in acute aortic dissection was suboptimal. The major cause of late failure was commissure detachment after primary repair with buttress sutures and glue. Gelatin-resorcinol-formaldehyde glue should be avoided for commissural resuspension in patients with acute aortic dissection.
- Published
- 2018
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