"Sleeve" Sinus of Valsalva Repair in Patients with Acute Type A Aortic Dissection
DOI:
https://doi.org/10.1532/hsf.3629Keywords:
Acute type A aortic dissection, Aortic Root Reconstruction, Aortic ValveAbstract
Purpose: The optimal surgical strategy of aortic root in acute type A aortic dissection (ATAAD) is controversial. The aim of this study was to evaluate the feasibility and safety of “Sleeve” Sinus of Valsalva repair for AAD limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia.
Methods: From September 2016 to March 2019, 20 patients with AAD involving non-coronary sinus or partial left and right coronary sinus Valsalva underwent “Sleeve” Sinus of Valsalva repair. A tailored Dacron patch was inserted into the dissected layers and two Dacron strips were placed inside and outside of the aorta, and the new five-layers root was sutured with 3/0 prolene continuous stitches. The artificial vessel was reversed about 1cm and anastomosed with the reconstructed root. Then, the reversed artificial vessel was pulled and anastomosed with the Dacron strip of the new proximal aorta.
Results: There was no early death in hospital and one death occurred during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only one patient and no bleeding was related to the proximal anastomosis. The postoperative drainage was 390.5 ± 229.3 mL. During follow up, the echocardiography showed the normal sinus of Valsalva and aortic valvular function. Computed tomography angiography showed normal aortic root without endovascular leak or dissection around the sinus of Valsalva. All patients were free from reoperation.
Conclusions: “Sleeve” Sinus of Valsalva repair with Dacron patch for aortic dissection limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia was technically feasible and safe.
References
Charitos EI, Stierle U, Sievers HH, et al. 2009. Valve-sparing aortic root remodeling with partial preservation of the intact native aortic sinuses. Eur J Cardiothorac Surg. 36(3):589-591.
David TE, Feindel CM, Bos J. 1995. Repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm. J Thorac Cardiovasc Surg. 109(2):345-351.
Estrera AL, Miller CC III, Villa MA, et al. 2007. Proximal reoperation after repaired acute type A aortic dissection. Ann Thorac Surg. 83 (5):1603–9.
Fleischman F, Elsayed RS, Cohen RG, et al. 2018. Selective Aortic Arch and Root Replacement in Repair of Acute Type A Aortic Dissection. Ann Thorac Surg. 105(2):505–512.
Geirsson A, Bavaria JE, Swarr D, et al. 2007. Fate of the residual distal and proximal aorta after acute type a dissection repair using a contemporary surgical reconstruction algorithm. Ann Thorac Surg. 84 (6):1955–64.
Komiya T, Tamura N, Sakaguchi G, et al. 2008. Modified partial aortic root remodeling in acute type A aortic dissection. Interact Cardiovasc Thorac Surg. 8(3):306-309.
Malvindi PG, van Putte BP, Sonker U, et al. 2013. Reoperation after acute type A Aortic dissection repair: a series of 104 patients. Ann Thorac Surg. 95 (3):922–8.
Movsowitz HD, Levine RA, Hilgenberg AD, et al. 2000. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol. 36(3):884-890.
Mussa FF, Horton JD, Moridzadeh R, et al. 2016. Acute aortic dissection and intramural hematoma: a systematic review. JAMA. 316 (7):754–63.
Pape LA, Awais M, Woznicki EM, et al. 2015. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends from the International Registry of Acute Aortic Dissection. Journal of the American College of Cardiology. Jul 28. 66(4):350–358.
Ro SK, Kim JB, Hwang SK, et al. 2013. Aortic root conservative repair of acute type A aortic dissection involving the aortic root: fate of the aortic root and aortic valve function. J Thorac Cardiovasc Surg. 146 (5):1113–8.
Rylski B, Bavaria JE, Milewski RK, et al. 2014. Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection. Ann Thorac Surg. 98(2):582–589.
Rylski B, Beyersdorf F, Blanke P, et al. 2013. Supracoronary ascending aortic replacement in patients with acute aortic dissection type A: what happens to the aortic root in the long run? J Thorac Cardiovasc Surg. 146 (2):285–90.
Tang Y, Liao Z, Han L, Tang H, et al. 2017. Long-term results of modified sandwich repair of aortic root in 151 patients with acute type A aortic dissection. Interact CardioVasc Thorac Surg. 25 (1):109–13.
Yang B, Norton EL, Hobbs R, et al. 2019. Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience. J Thorac Cardiovasc Surg. 157(6):2125–2136.
Zierer A, Voeller RK, Hill KE, et al. 2007. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg. 84 (2):479–87.
