The short-term effect of aortic sinoplasty on repairing aortic roots of patients with acute type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHANG Yi ,  QIAN Xiangyang , GUO Hongwei , WEI Yizhen , SHI Yi

Department of Vascular Surgery, Fu Wai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, 100037, P.R.China;

Corresponding author：

QIAN Xiangyang, Email: m13701097213@163.com

Keywords：

Aortic dissection; aortic root repair; ascending aorta replacement; surgery

DOI：

10.7507/1007-4848.202011020

Video：

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Objective To investigate the feasibility, effectiveness and durability of aortic sinoplasty in repairing aortic roots of patients with acute type A aortic dissection.Methods From January 2014 to July 2017, 43 consecutive patients with acute type A aortic dissection underwent aortic sinoplasty to repair aortic root in our institution, including 34 males and 9 females, aged 32-65 (50.1±8.1) years. The perioperative and follow-up data were retrospectively analyzed, and statistical analysis on the preoperative, postoperative and follow-up ultrasound indicators was performed.Results Thirty-day mortality was 4.7%. Preoperative aortic regurgitation was corrected and false lumen was eliminated immediately after operation in all patients. There was no late death, or aortic root or valve re-intervention and two patients were lost during a follow-up of 18-45 (27.9±6.7) months. There was no residual dissection found. No patients had significant dilation of aortic root. No statistically significant difference was found when comparing the maximum of root diameter and aortic regurgitation grade between at discharge and follow-up.Conclusion Aortic sinoplasty for aortic root repair in acute type A aortic dissection is a simple and reliable technique and demonstrates excellent early outcomes.

Citation： CHANG Yi, QIAN Xiangyang, GUO Hongwei, WEI Yizhen, SHI Yi. The short-term effect of aortic sinoplasty on repairing aortic roots of patients with acute type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1441-1446. doi: 10.7507/1007-4848.202011020 Copy

1.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13): e266-e369.
2.	Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg, 2010, 140(4): 784-789.
3.	Tan ME, Morshuis WJ, Dossche KM, et al. Long-term results after 27 years of surgical treatment of acute type A aortic dissection. Ann Thorac Surg, 2005, 80(2): 523-529.
4.	Concistrè G, Casali G, Santaniello E, et al. Reoperation after surgical correction of acute type A aortic dissection: Risk factor analysis. Ann Thorac Surg, 2012, 93(2): 450-455.
5.	Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325.
6.	Vallabhajosyula P, Szeto WY, Desai N, et al. Type Ⅱ arch hybrid debranching procedure. Ann Cardiothorac Surg, 2013, 2(3): 378-386.
7.	Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
8.	Rylski B, Bavaria JE, Milewski RK, et al. Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection. Ann Thorac Surg, 2014, 98(2): 582-588.
9.	Weinschelbaum EE, Schamun C, Caramutti V, et al. Surgical treatment of acute type A dissecting aneurysm, with preservation of the native aortic valve and use of biologic glue. Follow-up to 6 years. J Thorac Cardiovasc Surg, 1992, 103(2): 369-374.
10.	Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: Long-term echocardio graphic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517.
11.	Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233.
12.	Di Eusanio M, Trimarchi S, Peterson MD, et al. Root replacement surgery versus more conservative management during type A acute aortic dissection repair. Ann Thorac Surg, 2014, 98(6): 2078-2084.
13.	Zierer A, Voeller RK, Hill KE, et al. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 84(2): 479-486.
14.	Okita Y, Okada K, Omura A, et al. Surgical techniques of total arch replacement using selective antegrade cerebral perfusion. Ann Cardiothorac Surg, 2013, 2(2): 222-228.
15.	von Oppell UO, Karani Z, Brooks A, et al. Dissected aortic sinuses repaired with gelatin-resorcin-formaldehyde (GRF) glue are not stable on follow up. J Heart Valve Dis, 2002, 11(2): 249-257.
16.	Chen LW, Wu XJ, Li QZ, et al. A modified valve-sparing aortic root replacement technique for acute type A aortic dissection: The patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4): 731-733.
17.	Irimie V, Atieh A, Kucinoski G, et al. Long-term outcomes after valve-sparing anatomical aortic root reconstruction in acute dissection involving the root. J Thorac Cardiovasc Surg, 2020, 159(4): 1176-1184.
18.	Niederhäuser U, Künzli A, Seifert B, et al. Conservative treatment of the aortic root in acute type A dissection. Eur J Cardiothorac Surg, 1999, 15(5): 557-563.
19.	Westaby S, Saito S, Katsumata T. Acute type A dissection: Conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713.
20.	Urbanski PP, Zhan X, Frank S, et al. Aortic root reconstruction using new vascular graft. Interact Cardiovasc Thorac Surg, 2009, 8(2): 187-190.
21.	Tang YF, Zhang GX, Liao ZL, et al. Surgical treatment of coronary malperfusion with acute type A aortic dissection. Chin Med J (Engl), 2016, 129(8): 1000-1002.
22.	Ro SK, Kim JB, Hwang SK, et al. Aortic root conservative repair of acute type A aortic dissection involving the aortic root: Fate of the aortic root and aortic valve function. J Thorac Cardiovasc Surg, 2013, 146(5): 1113-1118.

1. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13): e266-e369.
2. Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg, 2010, 140(4): 784-789.
3. Tan ME, Morshuis WJ, Dossche KM, et al. Long-term results after 27 years of surgical treatment of acute type A aortic dissection. Ann Thorac Surg, 2005, 80(2): 523-529.
4. Concistrè G, Casali G, Santaniello E, et al. Reoperation after surgical correction of acute type A aortic dissection: Risk factor analysis. Ann Thorac Surg, 2012, 93(2): 450-455.
5. Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325.
6. Vallabhajosyula P, Szeto WY, Desai N, et al. Type Ⅱ arch hybrid debranching procedure. Ann Cardiothorac Surg, 2013, 2(3): 378-386.
7. Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
8. Rylski B, Bavaria JE, Milewski RK, et al. Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection. Ann Thorac Surg, 2014, 98(2): 582-588.
9. Weinschelbaum EE, Schamun C, Caramutti V, et al. Surgical treatment of acute type A dissecting aneurysm, with preservation of the native aortic valve and use of biologic glue. Follow-up to 6 years. J Thorac Cardiovasc Surg, 1992, 103(2): 369-374.
10. Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: Long-term echocardio graphic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517.
11. Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233.
12. Di Eusanio M, Trimarchi S, Peterson MD, et al. Root replacement surgery versus more conservative management during type A acute aortic dissection repair. Ann Thorac Surg, 2014, 98(6): 2078-2084.
13. Zierer A, Voeller RK, Hill KE, et al. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 84(2): 479-486.
14. Okita Y, Okada K, Omura A, et al. Surgical techniques of total arch replacement using selective antegrade cerebral perfusion. Ann Cardiothorac Surg, 2013, 2(2): 222-228.
15. von Oppell UO, Karani Z, Brooks A, et al. Dissected aortic sinuses repaired with gelatin-resorcin-formaldehyde (GRF) glue are not stable on follow up. J Heart Valve Dis, 2002, 11(2): 249-257.
16. Chen LW, Wu XJ, Li QZ, et al. A modified valve-sparing aortic root replacement technique for acute type A aortic dissection: The patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4): 731-733.
17. Irimie V, Atieh A, Kucinoski G, et al. Long-term outcomes after valve-sparing anatomical aortic root reconstruction in acute dissection involving the root. J Thorac Cardiovasc Surg, 2020, 159(4): 1176-1184.
18. Niederhäuser U, Künzli A, Seifert B, et al. Conservative treatment of the aortic root in acute type A dissection. Eur J Cardiothorac Surg, 1999, 15(5): 557-563.
19. Westaby S, Saito S, Katsumata T. Acute type A dissection: Conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713.
20. Urbanski PP, Zhan X, Frank S, et al. Aortic root reconstruction using new vascular graft. Interact Cardiovasc Thorac Surg, 2009, 8(2): 187-190.
21. Tang YF, Zhang GX, Liao ZL, et al. Surgical treatment of coronary malperfusion with acute type A aortic dissection. Chin Med J (Engl), 2016, 129(8): 1000-1002.
22. Ro SK, Kim JB, Hwang SK, et al. Aortic root conservative repair of acute type A aortic dissection involving the aortic root: Fate of the aortic root and aortic valve function. J Thorac Cardiovasc Surg, 2013, 146(5): 1113-1118.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The short-term effect of aortic sinoplasty on repairing aortic roots of patients with acute type A aortic dissection

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