The Aortic Root in Acute Type A Dissection: Repair or Replace?
This single-center study of 299 patients operated on for type-A aortic dissection between 1992 and 2020 reported lower ten-year mortality (32 percent) after prosthetic or valve-sparing root replacement compared with ascending aorta replacement (52 percent; hazard ratio, 1.38; 95 percent CI, 1.12-1.68) without resecting the coronary sinuses, and lower proximal aorta reoperation rates (14 percent vs 23 percent; hazard ratio, 2.08; 95 percent CI, 1.44-5.56). The authors conclude that aortic root replacement should be considered when the aortic root is partially dissected or pathologically dilated.
The most important consideration is whether the surgical team can perform complex surgeries. Generally, if dissection leads to severe aortic valve regurgitation, but the valve structure appears normal, I will choose total arch replacement combined with the David procedure. However, if the patient’s condition is poor, they are older, or the aortic valve is not in good condition, I would opt for the Bentall procedure.
Thank you very deeply and I hope to read this article