Strategies for treatment of acute aortic dissection with involvement of sinus of valsalva.

Received August 26, 2008; accepted for publication November 13, 2008 Address reprint requests to Toshihiro Fujimatsu, MD: Department of Cardiovascular Surgery, Heart Center, Aizawa Hospital, 2–5–1 Honjou, Matsumoto, Nagano 390–8510, Japan. ©2009 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved. Objective: The aim of this study was to assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA) with involvement of the aortic root. Materials and Methods: From November 2002 to December 2007, 51 consecutive patients underwent emergency surgical intervention for AADA with involvement of the aortic root. Supracommissural replacement (SCR) of the ascending aorta was applied to 33 of these patients; 12 cases received a Bentall procedure, and 6 underwent partial remodeling technique in which as much as the dissected aortic root was resected, leaving a rim of 10 mm above the noncoronary annulus and 5 mm above the coronary ostia and commissures. Woven Dacron graft tailored in a scallop-shaped configuration to match the noncoronary sinus was then anastomosed to the proximal aortic stump. Results: Overall hospital mortality was 16% and showed no significant differences among groups. SCR showed a trend toward higher aortic root morbidity. Mean operation time, cardiopulmonary bypass time, and cardiac ischemia time were significantly longer for the Bentall procedure. Conclusions: In AADA involving aortic root, a partial remodeling technique may be considered the surgical treatment of choice at our institution in suitable patients. (Ann Thorac Cardiovasc Surg 2009; 15: 382–388)