• James A Brown, Jianhui Zhu, Forozan Navid, Derek Serna-Gallegos, Rishabh Sehra, Nav Warraich, Valentino Bianco, Edgar Aranda-Michel, and Ibrahim Sultan.
• Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
• J. Thorac. Cardiovasc. Surg. 2024 Jun 1; 167 (6): 20372046.e22037-2046.e2.

ObjectiveTo determine the impact of aortic root preservation versus aortic root replacement (ARR) after acute type A aortic dissection (ATAAD) repair.MethodsIn this observational study of consecutive aortic surgeries between 2007 and 2021, patients with ATAAD were identified via a prospectively maintained institutional database and were stratified by root preservation versus ARR (including valve-sparing and complete ARR). Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed.ResultsAmong the 601 patients underwent aortic arch reconstruction for ATAAD, 370 (61.6%) underwent root preservation and the other 231 (38.4%) underwent ARR, with a median follow-up of 6.3 years (interquartile range, 3.8-9.6 years). Cardiopulmonary bypass and ischemic times were longer in the ARR group, but intraoperative variables were otherwise similar between the groups, including cannulation strategy and extent of distal repair. There were no between-group differences in postoperative outcomes, including operative mortality, stroke, mechanical ventilation time, renal failure, reexploration for bleeding, and total length of stay. At a 1-year follow-up, the incidence of aortic regurgitation (moderate or greater) was similar in the 2 groups. On multivariable Cox regression, ARR was not associated with improved long-term survival compared with root preservation (hazard ratio, 1.13; 95% confidence interval, 0.82-1.56; P = .44). Late reinterventions on the aortic root or valve were similar in the 2 groups and was 2.0% for the overall cohort.ConclusionsThese findings suggest that aortic root preservation may achieve similar midterm outcomes as ARR after ATAAD repair.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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