The fate of preserved aortic root after primary root reconstruction in acute type A aortic dissection−20 years´ experiences in Drum Tower

P0333 

Abstract Submission 

Yunxing Xue (1), Dongjin Wang (1), Qing Zhou (1), JUN PAN (1), Fudong Fan (1)

(1) Nanjing Drum Tower Hospital, Jiangsu, China

Yunxing Xue    -  Contact Me
Nanjing Drum Tower Hospital

Dongjin Wang    -  Contact Me
Nanjing Drum Tower Hospital

Qing Zhou    -  Contact Me
Nanjing Drum Tower Hospital

JUN PAN    -  Contact Me
Nanjing Drum Tower Hospital

Fudong Fan    -  Contact Me
Nanjing Drum Tower Hospital

Yunxing Xue    -  Contact Me
N/A

Background: The indications and methods for preserving the aortic root in acute type A aortic dissection are not clear. We retrospectively reviewed the treatment strategies based on 20 years´ experiences in Drum Tower hospital and analyzed the fate of preserved aortic root in the long−term period. Methods: From Jan. 2002 to Dec. 2021, 1705 acute type A aortic dissection cases were underwent surgical treatment in Drum Tower hospital. We divided them into three group according to different treatment periods: Stage 1 (2002-2010, n=78), Stage 2(2011-2018, n=880) and Stage 3 (2019-2021, n=747). The clinical manifestations, surgical methods and outcomes were compared among three groups. The anatomy classification of aortic root in aTAAD was confirmed by preoperative CTA, echocardiology and intraoperative direct vision: A1-Not involved or slightly involved; A2-Partially involved; A3Seriously involved. Double Jacket Wrapping method has been the main root reconstruction method for aTAAD after 2018. Results: The average age was 53.9 years (21-88 years old), no differences among three groups. The distribution of the three types is basically the same in the three groups: A1-5.6%, A2-78.1%, A3-16.3%. Bentall procedure accounted for 62.0% in Stage 1, while the proportion in Stage 2 and Stage 3 decreased significantly (28.6%, 16.5%, p<0.001). Root reconstruction repair procedure accounted for 32.0% in Stage 1 and significantly increased in Stage 2 and Stage 3 (68.3%, 74.5%, p<0.001). The 30-day mortality rate was 12.6% (15.4% vs 13.5% vs 9.8%, p<0.001). The 5-year survival rate was 82.3%, and the 10-year survival rate was 69.4%. During the follow-up period, the incidence of aortic root events was 1.3% (0.9% in Bentall group vs 2.1% in root repair group). After adjustment for survival rate, the rate of freedom from aortic root events in 5 year was 95%, in 10 year was 86%; and the surgical mortality of redo aortic root surgery was 5%. Conclusions: The aortic root treatment strategy of aTAAD requires a comprehensive selection based on the clinical characteristics of the patient, the pathological anatomy of the aortic dissection, and the surgical ability of the surgeon. The follow-up results also proved that compared with the long-term survival rate of type A dissection, the secondary intervention of preserved aortic root has less impact on patients. Double Jacket Wrapping method for aortic root reconstruction can be used as the mainstream way of root treatment for TAAD.

Aortic Root