ЗАДАТЬ ВОПРОС РЕДАКТОРУ РАЗДЕЛА (ответ в течение нескольких дней)

17 декабря 2001 00:00 | Filip P. Casselman, MDa, M. Erwin S.H. Tan, MDa, Freddy E.E. Ver

Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection

Filip P. Casselman, MD^a, M. Erwin S.H. Tan, MD^a, Freddy E.E. Vermeulen, MD^a, Johannes C. Kelder, MD^b, Wim J. Morshuis, MD, PhD^a, Marc A.A.M. Schepens, MD, PhD^a
^{a Department of Cardio-Thoracic Surgery, St. Antoniusziekenhuis, Nieuwegein, The Netherlands
^b Department of Cardiological Epidemiology, St. Antoniusziekenhuis, Nieuwegein, The Netherlands
Background. The aim of this study was to determine the durabilityof aortic valve preservation and root reconstruction in typeA aortic dissection with involvement of the aortic root.}

Methods. From November 1976 to February 1999, 246 patients underwentsurgical treatment for acute type A aortic dissection at ourinstitution. In 121 patients (49%), all with acute type A dissectionand aortic root involvement, the aortic valve was preservedand one or more of the sinuses of Valsalva were reconstructed.The mean age of this group was 59 ± 11 years and 70 (58%)were men. Thirty patients (25%) were operated in cardiogenicshock. Criteria for aortic root reconstruction were technicalfeasibility and surgeon preference. Techniques used for reconstructionwere valve resuspension in all patients and additional reinforcementof the aortic root with Teflon (L.R. Bard, Tempe, AZ) felt (n= 21), gelatin-resorcinol-formaldehyde-glue (GRF-glue, Fii,Saint-Just-Malmont, France) (n = 103), or fibrinous glue (Tissu-col,Immuno AG, Vienna, Austria) (n = 5). Mean follow-up was 43.5± 46 months.

Results. The operative mortality was 21.5% (n = 26). Actuarialsurvival was 72% ± 4%, 64% ± 5%, and 53% ±6% at 1, 5, and 10 years, respectively. Median aortic regurgitationin patients with retained native aortic valve at follow-up was1+. All root reoperations included aortic valve replacement(n = 12). Freedom from aortic root reoperation was 95% ±2% at 1 year, 89% ± 4% at 5 years, and 69% ± 9%at 10 years. The incidence of aortic root reoperation was 23%,11%, and 40%, respectively, when Teflon felt, GRF-glue, andfibrinous glue were used for root reconstruction. MultivariateCox proportional hazard analysis revealed the use of fibrinousglue (RR = 8.7; p = 0.03) as well as the presence of an aorticvalve annulus more than 27 mm (RR = 4.2; p = 0.04) as independentrisk factors for aortic root reoperation.

Conclusions. Aortic valve preservation in acute type A dissectionprovides relatively durable results. The use of fibrinous gluefor root reconstruction seems to compromise the long-term durabilityof the repair compared with Teflon felt and GRF-glue. A dilatedaortic annulus requires a more extensive root procedure.

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