Abstract 753: Acute Aortic Dissection Type A: Late Results of Different Treatment Strategies of the Aortic Root

The appropriate surgical treatment of the aortic root in acute aortic dissection type A (AADA) remains debatable. Here we assess the outcome of three different approaches in a large single centre cohort. From 01/1988 to 09/2007, we operated 242 patients for AADA. The aortic root was treated with valve resuspension with supracoronary replacement of the ascending aorta in 114 (SR), composite replacement in 104 (CR), and aortic valve sparing techniques in 26 patients (AVS; reimplantation n=11, remodelling n=15). In CR, patients were younger (52 vs. 59 vs. 59 years; p=0.002). Pericardial effusion was more frequent in AVS (p=0.015) and clinical status (NYHA) worse in CR (p=0.008). More patients from SR underwent previous cardiac surgery (p=0.035). Follow up was complete for 237 patients (98%). Extensions of dissection were comparable between groups (p=0.69). Aortic cross clamp times (SR;93±59 vs. CR;117±42 vs. AVS;105±38min.) differ significantly between groups (p=0.002). However, stay on ICU was comparable (p=0.45). Overall hospital mortality was 12.4 % and similar between groups (SR 14% vs. CR 13% vs. AVS 4.2%; p=0.41). In multivariate analysis, age was the only predictor for hospital mortality (OR 1.043, 95%CI 1.003–1.084; p=0.033). Incidence of neurological complications was similar between groups (p=0.13). Survival at 10 years was comparable with 41% for SR, 47% for CR and 62% for AVS (p=0.09). No patient from AVR required reoperation on the reconstructed valve. In acute aortic dissection, the different treatment strategies for the aortic root led to comparable results. Intraoperative judgement is justified for selection of individualized surgical strategy including valve sparing techniques.