Surgical Treatment for Acute Aortic Dissection with Involvement of Aortic Root_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

胡振雷 , 薛松 , 徐根兴 , 黄日太 , 刘沙 , 连锋

上海交通大学医学院附属仁济医院心血管外科，上海 200127;

Corresponding author：

Keywords：

Aortic dissection; 　Aortic surgery; 　Follow-up

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Abstract:　Objective　To evaluate surgical strategies for the treatment of acute Stanford type A aortic dissection with involvement of the aortic root.　Methods　From January 2005 to December 2010, 62 consecutive patients underwent emergency surgical intervention for acute Stanford type A aortic dissection with involvement of the aortic root in Renji Hospital Affiliated to Medical School of Shanghai Jiaotong University. According to different methods for the management of proximal aortic dissection, these patients were divided into 3 groups: group A, aortic valve commissural suspension＋supracommissural replacement of the ascending aorta （SCR）,including 28 patients （20 males and 8 females，mean age 45.2±15.6 years）; group B, partial sinus remodeling+ascending aortic replacement, including 10 patients （7 males and 3 females，mean age 44.6±14.9 years）；group C, Bentall procedure,including 24 patients （17 males and 7 females，mean age 46.2±15.6 years）. Clinical outcomes were compared among the three groups.　Results　Six patients died peri-operatively and in-hospital mortality was 9.67% （6/62）. Fifty-four patients were followed up, and the mean follow-up time was 27.3±15.7 months. During follow up, 2 patients died, one for lung cancer and the other for unknown reason. One patient in group A underwent CT scan 6 months after surgery which showed aortic root pseudo-aneurysm. Cardiopulmonary bypass time and aortic cross-clamping time of group C were significantly longer than those of group A and group B （274±97 min vs. 194±65 min, 210±77 min, t=22.482, 30.419, P=0.002， 0.122；150±56 min vs. 97±33 min, 105±46 min, t=12.630, 17.089, P=0.000，0.034）. There was no statistical difference in mortality （t=1.352，P=0.516）, incidence of postoperative reexploration for bleeding, acute renal failure and neurological complication （t=0.855, 0.342, 2.281; P=0.652, 0.863, 0.320） among the three groups.　Conclusion　For patients with acute aortic dissection involving the aortic root, aortic valve commissural suspension+SCR，partial sinus remodeling＋ascending aortic replacement and Bentall procedure may be considered the surgical treatment of choice with respective advantages and disadvantages. Satisfactory clinical outcomes can be achieveed if surgical indications and procedures are properly employed.

Citation： 胡振雷,薛松,徐根兴,黄日太,刘沙,连锋. Surgical Treatment for Acute Aortic Dissection with Involvement of Aortic Root. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 381-384. doi: Copy

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2.	Moon MR. Approach to the treatment of aortic dissection. Surg Clin North Am, 2009, 89 （4）：869-893.
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11.	Halstead JC, Spielvogel D, Dieter MM, et al. Composite aortic root replacement in acute type A dissection：time to rethink the indications? Eur J　Cardiothorac Surg, 2005, 27 （4）：.
12.	Van Putte BP, Ozturk S, Siddiqi s, et al. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg, 2012, 93 （2）：503-509.
13.	Tanaka M, Kimura N, Yamaguchi A, et al. In-hospital and long-term results of surgery for acute type A aortic dissection：243 consecutive patients. Ann Thorac Cardiovasc Surg, 2012, 18 （1）：18-23.
14.	Zizza A, Pano M, Zaccaria S, et al. Outcome of acute type A aortic dissection：single-center experience from 1998 to 2007. J Prev Med Hyg, 2009, 50 （3）：152-158.
15.	Borghetti V, Dionisi D, Principi M, et al. Aortic valve re-implantation technique with Gelweave Valsalva prosthesis：safety, reproducibility and pitfalls of a geometric reconstruction. J Cardiovasc Med, 2009, 10 （11）：834-841.
16.	Settepani F, Bergonzini M, Barbone A, et al. Reimplantation valve-sparing aortic root replacement with the Valsalva graft：what have we learnt after 100 cases ? Interact Cardiovasc Thorac Surg, 2009, 9 （1）：113-116.
17.	Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation （David I）. Eur J Cardiothorac Surg, 2012, 41 （1）：56-62.
18.	Kallenbach K, Pethig K, Leyh RG, et al. Acute dissection of the ascending aorta： first results of emergency valve sparing aortic root reconstruction. Eur J Cardiothorac Surg, 2002, 22 （2）： 218-222.
19.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J　Cardiothorac Surg, 2010, 37 （3）：691-696.
20.	Kimura N, Tanaka M, Kawahito K, et al. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2008, 136 （5）：1160-1166.
21.	-633.
22.	-1357.

1. 　Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection：Perspectives from the international registry of acute aortic dissection. Eur J Vasc Endovasc Surg, 2009, 37 （2）：149-59.
2. 　Moon MR. Approach to the treatment of aortic dissection. Surg Clin North Am, 2009, 89 （4）：869-893.
3. 　Rylski B, Suedkamp M, Beyersdorf F, et al. Outcome after surgery for acute aortic dissection type A in patients over 70 years： data analysis from the German Registry for Acute Aortic Dissection Type A （GERAADA）. Eur J Cardiothorac Surg, 2011, 40 （2）：435-440.
4. 　Kallenbach K, Oelze T, Salcher R, et al. Evolving strategies for treatment of acute aortic dissection type A. Circulation, 2004, 110 （11 Suppl 1）：Ⅱ243-249.
5. 　Hata H，Takano H，Matsumiya G，et a1. Late complications of gelatin resorcin formalin glue in the repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 83 （5）：1621-1626.
6. 　Suzuki S, Masuda M . An update on surgery for acute type A aortic dissection： aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39 （4）：281-289.
7. 　Concistre 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.
8. 　Itoh M, Okazaki Y, Ikeda K, et al. Partial aortic root remodeling for fistula between the non-coronary sinus and the right atrium. Heart Lung Circ, 2008, 17 （3）：243-263.
9. 　Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aorticdissection. Ann Thorac Surg, 2000, 70 （4）： 1227-1233.
10. 　Louis-Mathieu Stevens, Joren C. Madsen, Eric M. Isselbacher, et al. Surgical management and long-term outcomes for acute ascending　aortic dissection. J Thorac Cardiovasc Surg, 2009, 138 （6）：.
11. 　Halstead JC, Spielvogel D, Dieter MM, et al. Composite aortic root replacement in acute type A dissection：time to rethink the indications? Eur J　Cardiothorac Surg, 2005, 27 （4）：.
12. 　Van Putte BP, Ozturk S, Siddiqi s, et al. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg, 2012, 93 （2）：503-509.
13. 　Tanaka M, Kimura N, Yamaguchi A, et al. In-hospital and long-term results of surgery for acute type A aortic dissection：243 consecutive patients. Ann Thorac Cardiovasc Surg, 2012, 18 （1）：18-23.
14. 　Zizza A, Pano M, Zaccaria S, et al. Outcome of acute type A aortic dissection：single-center experience from 1998 to 2007. J Prev Med Hyg, 2009, 50 （3）：152-158.
15. 　Borghetti V, Dionisi D, Principi M, et al. Aortic valve re-implantation technique with Gelweave Valsalva prosthesis：safety, reproducibility and pitfalls of a geometric reconstruction. J Cardiovasc Med, 2009, 10 （11）：834-841.
16. 　Settepani F, Bergonzini M, Barbone A, et al. Reimplantation valve-sparing aortic root replacement with the Valsalva graft：what have we learnt after 100 cases ? Interact Cardiovasc Thorac Surg, 2009, 9 （1）：113-116.
17. 　Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation （David I）. Eur J Cardiothorac Surg, 2012, 41 （1）：56-62.
18. 　 Kallenbach K, Pethig K, Leyh RG, et al. Acute dissection of the ascending aorta： first results of emergency valve sparing aortic root reconstruction. Eur J Cardiothorac Surg, 2002, 22 （2）： 218-222.
19. 　Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J　Cardiothorac Surg, 2010, 37 （3）：691-696.
20. 　Kimura N, Tanaka M, Kawahito K, et al. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2008, 136 （5）：1160-1166.
21. -633.
22. -1357.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Acute Aortic Dissection with Involvement of Aortic Root

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