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

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

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.

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Data Availability

All data was derived from individual patient medical charts and is as a result not publicly available. De-identified data can be shared upon request as long as it is approved by the Emory Unversity IRB.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Parth Mukund Patel, Oreoluwa Elizabeth Olakunle, Andy Dong, Edward Chiou & Bradley Leshnower

  2. Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Jane Wei & Jose Binongo

  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

    Edward Po Chen

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  1. Parth Mukund Patel
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Correspondence to Edward Po Chen.

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This study was approved by the Emory University Institutional Review Board (eIRB 22795, date of approval 07/29/2009).

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Need for individual patient consent was waived given that all data was retrospectively collected.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Patel, P.M., Olakunle, O.E., Dong, A. et al. Acute type A aortic syndromes: outcomes are independent of aortic root/valve management. Indian J Thorac Cardiovasc Surg 40, 123–132 (2024). https://doi.org/10.1007/s12055-023-01602-8

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