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Conservative treatment of the aortic root in acute type A dissection


Niederhäuser, U; Künzli, A; Seifert, Burkhardt; Schmidli, J; Lachat, Mario L; Zünd, G; Vogt, P; Turina, M (1999). Conservative treatment of the aortic root in acute type A dissection. European Journal of Cardio-Thoracic Surgery, 15(5):557-563.

Abstract

Objective: In acute type A dissection long-term results of conservative aortic root surgery were compared with the outcome of primary valve and/or root replacement. Methods: Between 1985 and 1995, 199 patients (mean age 59 years, 154 men) were operated on. The aortic root was involved in the dissection process and valve incompetence of varying degree was present without exception. Replacement of a proximal aortic segment was standard procedure in all patients. The aortic valve was preserved in 126 patients: commissural suture resuspension (12 patients), root reconstruction with GRF-glue (gelatine-resorcin-formaldehyde/glutaraldehyde-glue) (114 patients). Valve replacement was performed in 73 patients (50 composite grafts, 23 valve prostheses with separate supracoronary grafts). Preoperative risk factors (valve replacement vs. preservation): coronary artery disease (11 vs. 8%, NS), tamponade (18 vs. 17%, NS), unstable hemodynamics (22 vs. 15%, NS), renal failure (4 vs. 6%, NS), neurologic disorder (19 vs. 32%, NS). Results: The overall early mortality was 23.6% (47/199 patients) and increased after commissural suture resuspension compared with GRF-glue reconstruction (P=NS). Parameters of the early postoperative period did not differ between conservative treatment and root/valve replacement: low cardiac output, 34 versus 38% (P=NS); myocardial infarction, 10 versus 11% (P=NS); hemorrhage, 25 versus 23% (P=NS); duration of intensive care (P=NS). Survival was 61% after 8 years without difference between the two principal treatment groups (P=NS) and between the two conservative subgroups (P=NS). At 2 years, GRF-glue reconstruction had an increased freedom from reoperation on the aortic root (92 vs. 70%, P=0.0253) and event free survival (77 vs. 41%, P=0.0224) compared with suture resuspension. Commissural suture resuspension was an independent, significant predictor for reoperation (P=0.0221, relative risk=4.7130). Conclusion: Surgery for acute type A dissection still carries a considerable early risk. Preservation of the aortic root is safe in the absence of Marfan or annuloaortic ectasia, but a certain incidence of reoperations on the aortic valve and the aortic root has to be accepted. Root reconstruction using GRF-glue is the method of choice and is superior to suture resuspension, with a significantly better reoperation-free and event-free survival.

Abstract

Objective: In acute type A dissection long-term results of conservative aortic root surgery were compared with the outcome of primary valve and/or root replacement. Methods: Between 1985 and 1995, 199 patients (mean age 59 years, 154 men) were operated on. The aortic root was involved in the dissection process and valve incompetence of varying degree was present without exception. Replacement of a proximal aortic segment was standard procedure in all patients. The aortic valve was preserved in 126 patients: commissural suture resuspension (12 patients), root reconstruction with GRF-glue (gelatine-resorcin-formaldehyde/glutaraldehyde-glue) (114 patients). Valve replacement was performed in 73 patients (50 composite grafts, 23 valve prostheses with separate supracoronary grafts). Preoperative risk factors (valve replacement vs. preservation): coronary artery disease (11 vs. 8%, NS), tamponade (18 vs. 17%, NS), unstable hemodynamics (22 vs. 15%, NS), renal failure (4 vs. 6%, NS), neurologic disorder (19 vs. 32%, NS). Results: The overall early mortality was 23.6% (47/199 patients) and increased after commissural suture resuspension compared with GRF-glue reconstruction (P=NS). Parameters of the early postoperative period did not differ between conservative treatment and root/valve replacement: low cardiac output, 34 versus 38% (P=NS); myocardial infarction, 10 versus 11% (P=NS); hemorrhage, 25 versus 23% (P=NS); duration of intensive care (P=NS). Survival was 61% after 8 years without difference between the two principal treatment groups (P=NS) and between the two conservative subgroups (P=NS). At 2 years, GRF-glue reconstruction had an increased freedom from reoperation on the aortic root (92 vs. 70%, P=0.0253) and event free survival (77 vs. 41%, P=0.0224) compared with suture resuspension. Commissural suture resuspension was an independent, significant predictor for reoperation (P=0.0221, relative risk=4.7130). Conclusion: Surgery for acute type A dissection still carries a considerable early risk. Preservation of the aortic root is safe in the absence of Marfan or annuloaortic ectasia, but a certain incidence of reoperations on the aortic valve and the aortic root has to be accepted. Root reconstruction using GRF-glue is the method of choice and is superior to suture resuspension, with a significantly better reoperation-free and event-free survival.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Aortic dissection, Ascending aorta, Aortic root, Aortic valve, Valve reconstruction, Composite graft
Language:English
Date:May 1999
Deposited On:15 Oct 2015 08:19
Last Modified:17 Jul 2018 16:43
Publisher:Oxford University Press
ISSN:1010-7940
OA Status:Green
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/S1010-7940(99)00079-2
PubMed ID:10386397

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