• Sven Peterss, Julia Dumfarth, John A Rizzo, Nikolaos Bonaros, Hai Fang, Maryann Tranquilli, Thomas Schachner, Bulat A Ziganshin, Michael Grimm, and John A Elefteriades.
• Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.
• Eur J Cardiothorac Surg. 2016 Aug 1; 50 (2): 232-9.

ObjectivesThe purpose of the study was to evaluate the operative outcome and the risk of retained proximal aortic tissue following the root-sparing (RS) technique in acute aortic dissection type A (AADA).MethodsBetween 2002 and 2014, 338 patients underwent repair of AADA; 74% of those were performed with the RS technique and 26% with root replacement (RR). The mean age was 62.4 ± 13.4 years (69% male) in the RS group and 56.1 ± 13.1 years (76% male) in the RR group (P < 0.001). Aortic insufficiency 2+ or higher was present in 35% (RS) and 72% (RR, P < 0.001), and bicuspid morphology in 1% (RS) and 16% (RR, P < 0.001).ResultsCardiopulmonary bypass time and cross-clamp time were significantly lower in the RS group (199 ± 71 vs 274 ± 110 min; 108 ± 46 vs 169 ± 55 min; P < 0.001 each), while no difference was seen with regard to distal operative extent, the use of circulatory arrest and adjunct protection strategies. The postoperative incidence of bleeding (18 vs 34%; P = 0.003), low cardiac output (14 vs 29%; P = 0.002) and sepsis/systemic inflammatory response syndrome (5 vs 12%; P = 0.037) were higher after RR, whereas mortality and survival did not differ between the groups. The aortic root grows at 0.40 ± 0.13 mm/year after AADA and thus, the need for potential reoperation was estimated at greater than 40 years. Freedom from root events after 5 and 10 years of follow-up was 97 and 92% in the RS group, and 100% each in RR group, respectively.ConclusionsBoth RS and RR procedures can be performed with an acceptable postoperative outcome and late survival in AADA. The RS approach can safely be performed with excellent results in acute survival and stabilizes the native root for a long period of time.© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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