Acute aortic dissection versus aortic root aneurysm: comparison of indications for valve sparing aortic root reconstruction

Objectives: To prove whether different indications for valve sparing aortic root reconstruction may have an impact on the outcome and longevity of the repair. Methods: From July 1993 to March 2003, the reimplantation technique for valve sparing aortic root reconstruction was applied to 232 patients. In 44 patients, indication for operation was acute aortic dissection type A (AADA). These patients were compared with 44 randomised patients operated for aortic root aneurysm (root) by matched pair analysis with respect to age, gender, time point of operation and presence of Marfan's syndrome. Peri- and post-operative courses with focus on survival and valvular stability were analysed. Results: Pre-operative grade of aortic insufficiency was 2.4 +/- 1 in root vs. 1.5 +/- 1.7 in AADA (P = 0.004). Mean CPB-time (214 +/- 60 vs. 171 +/- 42 min: P < 0.001), aortic cross clamp time (158 +/- 40 vs. 129 +/- 39 min; P = 0.001) and stay on ICU (5.2 +/- 9 vs. 1.7 +/- I days: P 0.034) were longer for AADA, while hospitalisation was comparable (14 +/- 10 vs. 14 +/- 7 days; P = 0.88). Five patients (11,4%) from AADA died peri-operatively compared to no patient from root (P = 0.055). None of the early deaths were valve-related. Rethoracotomy rate was 6.8% for both groups. Mean follow-up was 19 - 21 months for AADA vs. 28 - 21 months for root (P = 0.038). Survival at 3 years was 88 +/- 5% for AADA and 100% for root (P = 0.028). Freedom from valvular reoperation was 97 +/- 2.7% for root and 97 +/- 3% for AADA at 3 years (P = 0.44). At last investigation, mean grade of aortic insufficiency for AADA was 0.2 +/- 0.3 compared to 0.3 0.3 for root (P = 0.34). Conclusions: Regardless of the underlying indication, the aortic valve preserving reimplantation technique can be performed with favourable functional results. (C) 2004 Elsevier B.V. All rights reserved.