Aortic Root Reconstruction Provides Satisfactory Outcomes in Patients With Acute Type A Aortic Dissection

P0047 

Abstract Submission 

Yuki Ikeno (1), Akiko Tanaka (1), Alexander Mills (1), Lucas Ribe (1), Harleen Sandhu (1), Charles Miller (1), VIACHESLAV BOBOVNIKOV (1), steven eisenberg (1), Anthony Estrera (1)

(1) McGovern Medical School at UTHealth, Houston, TX

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
McGovern Medical School at UTHealth

Alexander Mills    -  Contact Me
McGovern Medical School at UTHealth

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Harleen Sandhu    -  Contact Me
McGovern Medical School at UTHealth

Charles Miller    -  Contact Me
McGovern Medical School at UTHealth

VIACHESLAV BOBOVNIKOV    -  Contact Me
McGovern Medical School at UTHealth

steven eisenberg    -  Contact Me
McGovern Medical School at UTHealth

*Anthony Estrera    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Objective:
Aortic root replacement (ARR) is performed in 20-30% of patients who present with acute type A aortic dissection in many aortic centers. We reviewed our two-decade experience to evaluate for the results of root conservation approach in acute type A aortic dissection ATAD.

Methods:
All open ATAD repairs performed at our institution from December 1999 to December 2023 were reviewed. Perioperative data were reviewed and patients who did not have ARR was compared with ARR.

Results:
Total of 770 patients had type A aortic repair during the study period. 75 (9%) patients had ARR, and modiced Bentall was the most common procedure (63%). Patients with ARR were younger (43 yo vs. 59 yo, P<0.001), more commonly male (87% vs. 69%, P<0.001), had hereditary thoracic aortic disease (53% vs. 6%, <0.0001), and had fewer comorbidities (COPD, CKD Stage greater than 3b, diabetes, coronary artery disease; all P<0.002). Median aortic root diameter prior to procedure was 40(IQR 36-44)mm in non-ARR group while that of ARR group was 54(IQR 48-65)mm. Aortic clamp time (95min vs 151min, P<0.001) and cardiopulmonary bypass time (150min vs. 198min, P<0.001) were shorter in non-ARR group but circulatory arrest time were longer (27min vs. 20min, P<0.001). Operative mortality was similar in 2 groups (non-ARR 13% vs. ARR 14%, P<0.804). Re-exploration for bleeding was significantly less in non-ARR (3% vs. 11%, P<0.008). In non-ARR group, 9 patients developed severe aortic insuhciency during follow-up and 12 patients had dilation of aortic root >50mm (of 12, 6 had severe AI) All the 9 severe AI underwent proximal re-intervention. There were 8 patients who did not have severe AI underwent proximal intervention at the time of redo total arch replacement with elephant trunk to prepare for distal intervention. There was no aortic root rupture. Reintervention-free survival was similar in 2 groups (10-year, non-ARR 52.2% ± 3.3% vs. ARR 59.1% ± 10.6% vs.).

Conclusions:
Patients without ARR were older and had more comorbidities. In acute type A aortic
dissection, aortic root conservation may be performed with reasonable early and late result.

Dissection