Long-Term Prognosis of Preserved Aortic Root after Open Repair for Acute Type A Aortic Dissection

P0201 

Abstract Submission 

Jung-Hwan Kim (1), Seung Hyun Lee (2), Sak Lee (3), Young-Nam Youn (2), Kyung-Jong Yoo (2), Hyun Chel Joo (4)

(1) Severance hospital, Seoul, Seoul, (2) Severance Cardiovascular Hospital, Seoul, AK, (3) Severance Hospital, Seoul, none, (4) Severance hospital, Seoul, seoul

Jung-Hwan Kim    -  Contact Me
Severance hospital

Seung Hyun Lee    -  Contact Me
Severance Cardiovascular Hospital

Sak Lee    -  Contact Me
Severance Hospital

Young-Nam Youn    -  Contact Me
Severance Cardiovascular Hospital

Kyung-Jong Yoo    -  Contact Me
Severance Cardiovascular Hospital

Hyun Chel Joo    -  Contact Me
Severance hospital

Jung-Hwan Kim    -  Contact Me
Severance hospital

Objective: The aim of this study was to investigate the long-term prognosis of the preserved, native aortic root after supra-coronary replacement in open repair for acute type A aortic dissection (ATAAD) and risk factors for root dilatation and aortic root re-operation.

Methods: Between 2001 and 2020, 238 consecutive patients (mean age, 62.6 ± 13.9 years) with ATAAD underwent supra-coronary replacement. The maximum diameter of aortic root was measured with computed tomography (CT) before-, immediate after surgery and every 1~2 years after surgery. The mean follow-up duration was 9.0 ± 5.9 years and the mean CT follow-up duration was 7.3 ± 5.02 years. End-points were aortic root re-operation, all-cause mortality and aortic root dilatation.

Results: There were 9 (3.8%) patients with Marfan syndrome and 1 (0.4%) with bicuspid aortic valve. The pre-operative mean aortic root diameter was 39.0 ± 5.4mm; 139 patients (58.4%) with <40mm, 66 patients (27.7%) with ≥40mm and <45mm, and 33 patients (13.9%) with ≥45mm. In-hospital mortality was 10.9%. The mean aortic root diameter increased from 48.6mm to 63.5mm in pre-operative aortic root ≥45mm patients, but it did not significantly increase (37.7mm to 38.9mm) in <45mm patients. Pre-operative aortic root ≥45mm patients showed significantly lower rates of 10-year aortic root re-operation free survival (73.5% vs. 99.4%, p<0.01) and overall survival (49.8% vs. 75.8%, p<0.01) than <45mm patients. The receiver operating characteristic curve showed aortic root re-operation was significantly corelated with pre-operative aortic root diameter (area under curve, 0.911; p<0.01) and optimal cut-off value was 45mm. Multivariate analysis showed that pre-operative aortic root ≥45mm was independent risk factor for aortic root re-operation (hazard ratio, 55.43 [6.79-452.80]; p<0.01) and all-cause death (hazard ratio, 3.41 [1.81-6.44]; p<0.01).

Conclusions: Pre-operative aortic root ≥45mm showed significantly higher risk of aortic root re-operation and late mortality because of the progressive aortic root dilatation.

Dissection