P136. Fate of Aortic Root after Aortic Repair for Acute Aortic Dissection in the Late Phase

Sheraton Times Square 

Objective: To evaluate the fate of the aortic root after surgery for acute aortic dissection and clarify the events of the aortic root after aortic repair for acute aortic dissection.
Methods: We studied 119 of 134 consecutive patients with Stanford type A aortic dissection who underwent emergency surgery at our hospital. We excluded two patients who had already undergone aortic root replacement at the time of initial surgery and 13 patients whose postoperative evaluation by contrast-enhanced computed tomography was not possible due to deterioration in their postoperative condition. All patients underwent proximal anastomosis with felt strips and biologic glue reinforcement. There were no patients with connective tissue disease. The primary endpoint is all-cause mortality, and the second endpoint is open aortic reintervention.
Results: Of the 119 patients, 14 patients showed residual dissection in the aortic root and four patients showed pseudoaneurysm in the aortic root. In total, four patients died and nine patients required open aortic reintervention, during follow-up. Cases with residual root dissection were detected from postoperative computed tomography, within one week postoperatively; however, all cases were followed conservatively. All cases of pseudoaneurysm, which were detected between 45 to 792 days postoperatively, underwent redo surgery with patch repair to the pseudoaneurysm. At reopening, the anastomosis appeared completely detached and almost ruptured in all cases. In one case, pathologically complete necrosis of the aortic wall was detected and this may have been caused by the biologic glue. There was no significant difference in all-cause mortality (p = 0.51) between the 18 cases with aortic root events and 101 cases without; however, there was a significant difference (p =0.0015) in open aortic reintervention in these groups.
Conclusions: Although the residual aortic root dissections may have been due to inadequate repair of the proximal anastomoses, these can be followed conservatively without any aortic root events. Alternatively, in cases with aortic root pseudoaneurysms due to necrosis of the aortic wall, prompt surgical intervention is recommended. Although felt strips and biologic glue are useful in controlling anastomotic bleeding in aortic dissections, in essence, they do not cure the dissection and should be deployed with the appropriate amount of use.

Authors
Kayo Sugiyama (1), Hirotaka Watanuki (2), Masato Tochii (3), Daisuke Koiwa (2), Katsuhiko Matsuyama (4)
Institutions
(1) N/A, Japan, (2) Aichi Medical University Hospital, Nagakute, NA, (3) Fujita Health University, Toyoake, Japan, (4) N/A, Tokyo, Japan

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