Acute type A aortic syndromes: outcomes are independent of aortic root/valve management.

PURPOSE: Clinical outcomes following various surgical intervention strategies for aortic root and valve pathology during repair of acute type A aortic syndromes were studied and compared.

METHODS: From 2004 to 2019, 634 patients underwent acute type A aortic repair. Patients were divided into 4 groups: Valve Resuspension ( n  = 456), Isolated Valve Replacement (AVR) ( n  = 24), Valve and Root Replacement (ROOT) ( n  = 97), and Valve Sparing Root Replacement (VSRR) ( n  = 57). The primary endpoint was midterm survival and multivariable risk factor analysis was performed.

RESULTS: The mean age was 55.4 ± 13 years, 424 (67%) were male, and overall early mortality was 12%. Early mortality was 13%, 8%, 11%, and 7% for the Valve Resuspension, AVR, ROOT, and VSRR groups respectively, p  = 0.43. Five-year survival was 74%, 86%, 73%, and 84% for the Valve Resuspension, AVR, ROOT, and VSRR groups respectively, p  = 0.46. There was no difference in late stroke, renal failure, heart block, and late bleeding ( p  > 0.05 for all). At late follow-up, AVR and ROOT patients had a higher mean gradient versus Valve Resuspension and VSRR patients, p  < 0.0001. For the total cohort, risk factors for late mortality included preoperative peripheral vascular disease (hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.2-4.4, p  = 0.009) and preoperative dialysis (HR 2.8, 95% CI 1.3-6.1, p  = 0.01).

CONCLUSION: Mid-term survival following repair of acute type A aortic dissection is not independently associated with a specific type of aortic valve intervention. Native valve preservation leads to acceptable mid-term valve hemodynamics and should be the preferred therapy in this emergent clinical setting.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-023-01602-8.