Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root

Qing-qi Han, Zhi-gang Song, Liang-jian Zou, Lin Han, Fang-lin Lu, Xi-long Lang, Zhi-yun Xu
2013 Brazilian Journal of Cardiovascular Surgery  
190 Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(2):190-9 Han Q, et al. -Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root RBCCV 44205-1457 Abstract Objective: There are debates regarding the optimal approach for AAAD involving the aortic root. We described a modified reinforced aortic root reconstruction approach for treating AAAD involving the aortic root. Methods: A total of 161 patients with AAAD involving
more » ... ith AAAD involving the aortic root were treated by our modified reinforced aortic root reconstruction approach from January 1998 to December 2008. Key features of our modified approach were placement of an autologous pericardial patch in the false lumen, lining of the sinotubular junction lumen with a polyester vascular ring, and wrapping of the vessel with Teflon strips. Outcome measures included post-operative mortality, survival, complications, and level of aortic regurgitation. Results: A total of 161 patients were included in the study (mean age: 43.3 ± 15.5 years). The mean duration of follow-up was 5.1 ± 2.96 years (2-12 years). A total of 10 (6.2%) and 11 (6.8%) patients died during hospitalization and during followup, respectively. Thirty-one (19.3%) patients experienced postoperative complications. The 1-, 3-, 5-, and 10-year survival rates were 99.3%, 98%, 93.8%, and 75.5%, respectively. There were no instances of recurrent aortic dissection, aortic aneurysm, or pseudoaneurysm during the entire study period. The severity of aortic regurgitation dramatically decreased immediately after surgery (from 28.6% to 0% grade 3-4) and thereafter slightly increased (from 0% to 7.2% at 5 years and 9.1% at 10 years). Conclusion: This modified reinforced aortic root reconstruction was feasible, safe and durable/effective, as indicated by its low mortality, low postoperative complications and high survival rate. Descriptors: Aneurysm, dissecting. Aortic diseases/surgery. Aorta/surgery. Resumo Objetivo: Há um debate sobre a melhor abordagem para dissecção aguda da aorta tipo A (DAAA) envolvendo a raiz da aorta. Nós descrevemos abordagem aórtica reforçada modificada de reconstrução de raiz para o tratamento DAAA envolvendo a raiz da aorta. Métodos: Um total de 161 pacientes com DAAA envolvendo a raiz da aorta foram tratados pelo nosso abordagem reforçada modificada da reconstrução da raiz da aorta de janeiro de 1998 a dezembro de 2008. As características-chave da nossa ORIGINAL ARTICLE 191 Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(2):190-9 Han Q, et al. -Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root abordagem modificada foram a colocação de um remendo de pericárdio autólogo na falsa luz, forro do lúmen supravalvar com um anel vascular, poliéster e envolvimento dos vasos com tiras de teflon. A avaliação pós-operatória incluiu mortalidade, sobrevivência, complicações, e grau de insuficiência aórtica. Resultados: Um total de 161 pacientes foram incluídos no estudo (média de idade: 43,3 ± 15,5 anos). A duração média de acompanhamento foi de 5,1 ± 2,96 anos (2-12 anos). Um total de 10 (6,2%) e 11 (6,8%) pacientes morreram durante a internação e durante o acompanhamento, respectivamente. Trinta e um (19,3%) pacientes apresentaram complicações pós-operatórias. A 1 -, 3 -, 5 -, e as taxas de sobrevivência de 10 anos foram 99,3%, 98%, 93,8% e 75,5%, respectivamente. Não houve casos de dissecção aórtica recorrente, aneurisma ou pseudoaneurisma da aorta durante o período de estudo. A gravidade da regurgitação aórtica diminuiu drasticamente logo após a cirurgia (de 28,6% para grau 0 de 3-4%) e, posteriormente, teve ligeiro aumento (de 0% a 7,2% em 5 anos e de 9,1% aos 10 anos). Conclusão: A reconstrução da raiz da aorta reforçada modificada é viável, segura e durável/eficaz, como indicado pelas baixas mortalidade e complicações pós-operatórias e taxa de sobrevivência elevada. Descritores: Aneurisma dissecante. Doenças da aorta/ cirurgia. Aorta/cirurgia. Abbreviations, Acronyms & Symbols Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(2):190-9 Han Q, et al. -Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(2):190-9 Han Q, et al. -Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(2):190-9 Han Q, et al. -Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(2):190-9 Han Q, et al. -Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root
doi:10.5935/1678-9741.20130028 pmid:23939315 fatcat:vzj56nyelve7hipcszqbztlho4