Outcomes of valve-sparing root replacement in acute Type A aortic dissection.

OBJECTIVES: To investigate the long-term durability of aortic valves, we reviewed the outcomes of patients who underwent valve-sparing root replacement with acute Type A aortic dissection.

METHODS: We included patients who underwent emergent aortic repair for acute Type A aortic dissection at our university hospital between 2000 and 2016. We identified patients who underwent valve-sparing root replacement from the included cohort and assessed their survival and long-term valve durability.

RESULTS: We identified 24 of 328 patients who underwent valve-sparing root replacement (age: mean ± SD 49 ± 11 years; 17 men). All patients underwent reimplantation procedures and 2 had concomitant cusp repairs (central plication). Prolapsed cusps caused by detached commissures in 12 cases were noted and reattached with buttress sutures with or without glue. There was no in-hospital mortality. Median follow-up period was 84 months (range 1-202 months) and survival was 100% at 5 and 10 years. Freedom from moderate or greater aortic insufficiency was 82% ± 10% at 5 years and 65% ± 13% at 10 years. Freedom from aortic valve reoperation was 83% ± 9% at 5 years and 69% ± 12% at 10 years. Valve reoperations were indicated for endocarditis in 1 patient, perforation of the aortic cusp in 1 patient and redetachment of commissures that had been attached with gelatin-resorcinol-formaldehyde glue at the initial operations in 3 patients.

CONCLUSIONS: The durability of valve-sparing root replacement in acute aortic dissection was suboptimal. The major cause of late failure was commissure detachment after primary repair with buttress sutures and glue. Gelatin-resorcinol-formaldehyde glue should be avoided for commissural resuspension in patients with acute aortic dissection.