Fate of the Preserved Sinuses of Valsalva After Emergency Repair for Acute Type A Aortic Dissection.
Publication/Presentation Date
11-1-2020
Abstract
BACKGROUND: Patients with acute type A aortic dissection (ATAAD) present with heterogeneous involvement of the aortic root complex. Despite this variation, the aortic root can usually be preserved the majority of the time by Teflon (WL Gore, Newark, DE) inlay patch reconstruction of the dissected sinuses of Valsalva (SOV). In this study, we report the long term anatomic, functional, and clinical outcomes associated with the preserved SOV after surgery for ATAAD.
METHODS: From 2002-2017, of 776 emergency ATAAD operations at a single institution, 558 (71.9%) underwent valve resuspension with SOV preservation. Echocardiography reports were reviewed to obtain postoperative SOV dimensions. Cumulative incidence of SOV dilation ≥ 4 5mm was calculated using the Fine-Gray method with death as a competing risk. Repeated-measures linear mixed effects model was used to determine risk factors for SOV growth over time.
RESULTS: During the follow-up period, 62 of 558 (11.1%) patients developed SOV diameter ≥ 45 mm. Cumulative incidence of SOV dilation ≥ 45 mm at 1, 5, and 10 years was 5.5%, 12.4%, and 18.9% respectively. In a multivariable Cox regression model, preoperative SOV diameter ≥ 45 mm was associated with a hazard ratio of 14.11 (95% confidence interval 7.03-31.62) for postoperative SOV dilation ≥ 45 mm. In a repeated-measures linear mixed effects model, preoperative and discharge SOV diameter were significant predictors of SOV dilation. Postoperative time course was also identified as significant indicating growth over time.
CONCLUSIONS: The preserved sinuses of Valsalva after surgery for ATAAD may be prone to progressive dilatation over time. Closer echocardiographic surveillance may be warranted in these patients.
Volume
110
Issue
5
First Page
1476
Last Page
1483
ISSN
1552-6259
Published In/Presented At
Bojko, M. M., Suhail, M., Bavaria, J. E., Habertheuer, A., Hu, R. W., Harmon, J., Desai, N. D., Milewski, R. K., Williams, M. L., Szeto, W. Y., & Vallabhajosyula, P. (2020). Fate of the Preserved Sinuses of Valsalva After Emergency Repair for Acute Type A Aortic Dissection. The Annals of thoracic surgery, 110(5), 1476–1483. https://doi.org/10.1016/j.athoracsur.2020.01.083
Disciplines
Medicine and Health Sciences
PubMedID
32156587
Department(s)
Department of Surgery
Document Type
Article