Objective : To determine the long-term durability of aortic valve resuspension during surgery for acute Type A dissection with involvement of the aortic root.
Methods : From 1976 to 1999, 121 patients underwent surgery for acute Type A aortic dissection with preservation of the aortic valve and sinuses of Valsalva. Mean age was 59+11 years and 58% were male. Thirty patients (25%) were operated in cardiogenic shock. Techniques used for aortic valve preservation were valve resuspension in all patients and additional reinforcement of the aortic root with Teflon ® felt (n = 53), GRF-glue ® (n = 103) or fibrinous glue (n = 5). Mean follow-up was 43.5 +46 months.
Results : The operative mortality was 21.5% (n = 26). Actuarial survival was 75.7 +5%, 75.7 +7% and 75.7 +14% at 1, 5 and 10 years respectively. Reoperations included aortic valve replacement in 12 patients. Freedom from aortic valve reoperation was 95+3% at 1 year, 89 +5% at 5 years and 69 +16% at 10 years. Mean grade of aortic regurgitation on transthoracic echocardiogram in the non-reoperated group was 1.1 +0.8 at the time of follow-up. Cox analysis revealed the use of Teflon ® felt (RR = 9.8; p = 0.03) and fibrinous glue (RR = 10.3; p = 0.03) as well as the presence of a dilated aortic annulus (RR = 23.8; p = 0.002) as independent risk factors for aortic valve reoperation.
Conclusion : Aortic valve preservation in acute Type A dissection provides good long-term results. The use of Teflon ® felt or fibrinous glue for root reconstruction seems to compromise the long-term durability of the aortic valve repair. A dilated aortic annulus requires a more extensive root procedure.