BACKGROUND: Extensive surgical resection of the thoracic aorta in patients with type A aortic dissection (TAAD) is thought to reduce the risk of late aortic wall degeneration and the need for repeat aortic operations. OBJECTIVES: We evaluated the early and late outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root. DESIGN: Retrospective, multicenter cohort study. METHODS: The outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root, that is dissection flap located at least in one of the Valsava segments, were herein evaluated. In-hospital mortality, neurological complications, dialysis as well as 10-year repeat proximal aortic operation, and mortality were the outcomes of this study. RESULTS: Supracoronary ascending aortic replacement was performed in 198 patients and aortic root replacement in 215 patients. During a mean follow-up of 4.0 ± 4.0 years, 19 patients underwent 22 repeat procedures on the aortic root and/or aortic valve. No operative death occurred after these reinterventions. The risk of proximal aortic reoperation was significantly lower in patients who underwent aortic root replacement (5.5% vs 12.9%, adjusted subdistributional hazard ratio (SHR) 0.085, 95% CI 0.022-0.329). Aortic root replacement was associated with higher rates of in-hospital (14.4% vs 12.1%, adjusted odds ratio 2.192, 95% CI 1.000-4.807) and 10-year mortality (44.5% vs 30.4%, adjusted hazard ratio 2.216, 95% CI 1.338-3.671). Postoperative neurological complications and dialysis rates were comparable in the study groups. CONCLUSION: Among patients with TAAD involving the aortic root, its replacement was associated with a significantly lower rate of repeat proximal aortic operation of any type compared to supracoronary aortic replacement. Still, aortic root replacement seems to be associated with an increased risk of mortality in these patients. UNLABELLED: ClinicalTrials.gov: NCT04831073 (https://clinicaltrials.gov/study/NCT04831073).

Cardiac Surgery Molinette Hospital University of Turin Turin Italy

Cardiothoracic Department Azienda Sanitaria Universitaria Friuli Centrale Udine Italy

Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain

Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy

Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France

Department of Cardiac Surgery Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiac Surgery Glenfield Hospital Leicester UK

Department of Cardiac Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris Creteil France

Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University Munich Germany

Department of Cardiac Surgery Martin Luther University Halle Wittenberg Halle Germany

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany

Department of Cardiovascular Surgery Centro Cardiologico Monzino IRCCS Milan Italy

Department of Cardiovascular Surgery Centro Cardiologico Monzino IRCCS Via Carlo Parea 4 Milan 20138 Italy

Department of Cardiovascular Surgery Hospital Clínic de Barcelona University of Barcelona Barcelona Spain

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland

Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France

Division of Cardiac Surgery Cardio thoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy

Division of Cardiac Surgery University of Verona Medical School Verona Italy

Faculty of Medicine University of Oulu Oulu Finland

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

National Center for Global Health Istituto Superiore di Sanitá Rome Italy

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ClinicalTrials.gov
NCT04831073