Survival and reoperation after valve-sparing root replacement and root repair in acute type A dissection

Objective: Optimal treatment of the dissected root in type A dissection is still controversial. Valve-sparing techniques offer the advantage of better valve performance compared with mechanical valves or bioprostheses. The role of the different valve-preserving methods-root repair and replacement-needs further evaluation. Methods: Follow-up data (median follow-up, 11.4 years; 95 % confidence interval [CI], 10.1-12.7; range, 0-22.1 years) of 179 patients with acute type A dissection and root involvement, who underwent a valve-sparing root replacement using reimplantation (n = 44) or remodeling (n = 39) or a valve-sparing root repair (n = 96) between 1993 and 2017 were analyzed with respect to survival and reoperation. Results: Median age of patients with reimplantation was 56.9 (range, 20.2-78), with remodeling 62.6 (range, 31-79.1), and with valve-sparing root repair 64.5 (range, 31-89.6) years. Thirty-day mortality for these groups was 15.9%, 15.4%, and 12.5% (P = .829), late mortality at 15 years was 43.2% (95% CI, 28.1-66.5), 36.7% (95% CI, 19.7-68.1), and 36.5% (95% CI, 23.0-57.9; P = .504). Risk factors for overall mortality were age, connective tissue disease, total arch replacement, surgical time, cross-clamp time, circulatory arrest, and the reimplantation technique. Cumulative incidence of reoperation at 15 years was 13.4% (95% CI, 2.1-24.7), 20% (95% CI, 6.3-33.6), and 13.3% (95% CI, 4.8-21.7; P = .565), respectively. Conclusions: With the different conditions in each group in this study on patients with acute type A dissection the valve-preserving root repair technique has similar long-term rates of survival and reoperation compared with root replacement techniques, underlining its usefulness as a less complex and even faster surgical technique if individually indicated.