Artikel
Back to the roots – Outcome on aortic bulbus after supracoronary aortic replacment in acute aortic dissection type A
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Veröffentlicht: | 26. April 2013 |
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Introduction: Valve-sparing surgery is an often used method in acute aortic dissection type A. The aim of this study was to evaluate mid-term results after supracoronary aortic replacement with regard to the aortic root.
Material and methods: Between January 2006 and February 2011, we operated on 100 patients with acute aortic dissection type A. Out of these, 74 patients underwent supracoronary aortic replacement. Diameter of the aortic root and valve insufficiency were assessed by computed tomography and echocardiography on follow-up in 29 patients.
Results: The mean age of the patient population was 59.2±13.8 years, 29 patients being female. Overall 30-day mortality rate was 15%. Mean follow-up time was 25.9±16.5 months. On follow-up CT scan, dilatation of the aortic root (>4 cm) was observed in 48.3%. Indication for reoperation based on root dissection or critical dilatation of the aortic root (>5,2 cm) was made in 27.6% of all patients treated with supracoronary aortic replacement. Mild aortic regurgitation was found in 50%, one patient had moderate aortic regurgitation in echocardiography.
Conclusion: The supracoronary aortic replacement was associated with a high incidence of aortic root dilatation or dissection after mid-term follow-up, with a high indication for reoperation. Closer follow-up for patients after supracoronary replacement after acute dissection type A is necessary. During operation, quality of aortic wall, aneurysm of ascending aorta, dilatation of aortic bulbus and valve insufficiency should be examined thoroughly. In case of doubt, surgical treatment according to Bentall or a David procedure should be considered more often in these patients.