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

Parth Mukund Patel; Oreoluwa Elizabeth Olakunle; Andy Dong; Edward Chiou; Jane Wei; Jose Binongo; Bradley Leshnower; Edward Po Chen

doi:10.1007/s12055-023-01602-8

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

Indian J Thorac Cardiovasc Surg. 2024 Mar;40(2):123-132. doi: 10.1007/s12055-023-01602-8. Epub 2023 Oct 19.

Authors

Parth Mukund Patel¹, Oreoluwa Elizabeth Olakunle¹, Andy Dong¹, Edward Chiou¹, Jane Wei², Jose Binongo², Bradley Leshnower¹, Edward Po Chen³

Affiliations

¹ Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA USA.
² Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA USA.
³ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Duke University Medical Center, 2310 Erwin Road, 8660 HAFS Building, Durham, NC 27710 USA.

PMID: 38389780
PMCID: PMC10879474 (available on 2025-03-01)
DOI: 10.1007/s12055-023-01602-8

Abstract

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.

Keywords: Aortic dissection; Aortic root, Aortic valve; Outcomes; Reoperation.

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