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Preservation versus replacement of the aortic root during aortic arch reconstruction for acute Type A aortic dissection
James Brown, Forozan Navid, Derek Serna-Gallegos, Rishabh Sehra, Nav Warraich, Valentino Bianco, Edgar Aranda-Michel, Ibrahim Sultan.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Objective: Outcomes of aortic root preservation after acute Type A aortic dissection (ATAAD) are not well characterized, compared to aortic root replacement (ARR). This study sought to determine the impact of root preservation vs. ARR after aortic arch surgery for ATAAD.Methods: This was an observational study of consecutive aortic surgeries from 2007 and 2018. Patients with ATAAD were identified via a prospectively maintained institutional database and were stratified by root preservation vs. ARR (including valve-sparing or full ARR). Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed.Results: A total of 493 patients underwent aortic arch reconstruction for ATAAD. Of these, 300 (60.9%) underwent root preserving surgery, while 193 (39.1%) had ARR, with a median follow-up of 4.1 years (IQR: 2.4, 7.1). Patients undergoing ARR were younger, had more redo sternotomy, more bicuspid aortic valves, more preoperative aortic insufficiency ≥ moderate, and less shock on presentation than patients undergoing root preservation, but the groups were otherwise similar across baseline comorbidities (p>0.05). Cardiopulmonary bypass and ischemic time were longer in the ARR group, but the proportion of hemiarch and total arch replacements were similar across each group (p>0.05). There were no differences in postoperative outcomes across each group (p>0.05, see Table). On multivariable Cox regression, ARR was not associated with improved long-term survival (OR 1.09, 95% CI: 0.69, 1.71, p=0.713), as compared to root preservation.Conclusions: These findings suggest that aortic root preservation may achieve similar midterm outcomes as ARR in the setting of aortic arch reconstruction for ATAAD.


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