Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation

Renzo Pessotto, Francesco Santini, Peppino Pugliese, Giuseppe Montalbano, Giovanni Battista Luciani, Giuseppe Faggian, Paolo Bertolini, Alessandro Mazzucco

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Abstract

Background. The aim of the present study was to verify the efficacy of preserving the aortic valve in patients with acute type A aortic dissection complicated by significant aortic regurgitation. Methods. From January 1979 to December 1996, 178 patients (125 males; mean age 57 ± 9 years) underwent emergency surgery for acute type A aortic dissection, with an overall operative mortality rate of 21%. based on a retrospective analysis of the preoperative angio- or echocardiographic findings, the 141 survivors were divided into 2 groups: Group 1 (G1) included 80 patients (57%) with no or mild aortic regurgitation, and Group 2 (G2) the remaining 61 patients with moderate-to-severe aortic regurgitation. The native aortic valve was preserved by means of a uniform technique consisting of reconstruction of the aortic root and sinotubular junction in 99 patients (70%) [68 in G1 (85%) and 31 in G2 (51%)]. Forty-two patients required aortic valve (8 patients; 6%) or total root replacement (34 patients; 24%). Results. At a mean follow-up of 4 ± 3.6 years (range, 6 months to 19 years), 19 of the 99 patients with a preserved aortic valve developed moderate-to-severe aortic insufficiency [19%; 7/68 in G1 (10%) and 12/31 in G2 (39%)]. Multivariate analysis revealed that moderate-to-severe preoperative aortic valve insufficiency was a significant risk factor for development of postoperative aortic valve regurgitation (p = 0.008). Reoperation was necessary in 7 G1 patients (10%) and in 8 G2 patients (26%), with an actuarial freedom from reoperation at 5 and 10 years of 93% ± 7% and 80% ± 9% in G1 patients, and 81% ± 8% and 40% ± 15% in G2 patients (p = 0.045). Conclusions. Preservation of the aortic valve and aortic root is recommended in patients with acute type A aortic dissection and absent or mild aortic insufficiency. Patients presenting with moderate-to-severe aortic regurgitation and treated conservatively present an increased risk of recurrent valvular insufficiency.

Original languageEnglish
Pages (from-to)2010-2013
Number of pages4
JournalAnnals of Thoracic Surgery
Volume67
Issue number6
DOIs
Publication statusPublished - Jun 1999

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Aortic Valve Insufficiency
Aortic Valve
Dissection
Reoperation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Pessotto, R., Santini, F., Pugliese, P., Montalbano, G., Luciani, G. B., Faggian, G., ... Mazzucco, A. (1999). Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation. Annals of Thoracic Surgery, 67(6), 2010-2013. https://doi.org/10.1016/S0003-4975(99)00417-8

Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation. / Pessotto, Renzo; Santini, Francesco; Pugliese, Peppino; Montalbano, Giuseppe; Luciani, Giovanni Battista; Faggian, Giuseppe; Bertolini, Paolo; Mazzucco, Alessandro.

In: Annals of Thoracic Surgery, Vol. 67, No. 6, 06.1999, p. 2010-2013.

Research output: Contribution to journalArticle

Pessotto, R, Santini, F, Pugliese, P, Montalbano, G, Luciani, GB, Faggian, G, Bertolini, P & Mazzucco, A 1999, 'Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation', Annals of Thoracic Surgery, vol. 67, no. 6, pp. 2010-2013. https://doi.org/10.1016/S0003-4975(99)00417-8
Pessotto, Renzo ; Santini, Francesco ; Pugliese, Peppino ; Montalbano, Giuseppe ; Luciani, Giovanni Battista ; Faggian, Giuseppe ; Bertolini, Paolo ; Mazzucco, Alessandro. / Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation. In: Annals of Thoracic Surgery. 1999 ; Vol. 67, No. 6. pp. 2010-2013.
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abstract = "Background. The aim of the present study was to verify the efficacy of preserving the aortic valve in patients with acute type A aortic dissection complicated by significant aortic regurgitation. Methods. From January 1979 to December 1996, 178 patients (125 males; mean age 57 ± 9 years) underwent emergency surgery for acute type A aortic dissection, with an overall operative mortality rate of 21{\%}. based on a retrospective analysis of the preoperative angio- or echocardiographic findings, the 141 survivors were divided into 2 groups: Group 1 (G1) included 80 patients (57{\%}) with no or mild aortic regurgitation, and Group 2 (G2) the remaining 61 patients with moderate-to-severe aortic regurgitation. The native aortic valve was preserved by means of a uniform technique consisting of reconstruction of the aortic root and sinotubular junction in 99 patients (70{\%}) [68 in G1 (85{\%}) and 31 in G2 (51{\%})]. Forty-two patients required aortic valve (8 patients; 6{\%}) or total root replacement (34 patients; 24{\%}). Results. At a mean follow-up of 4 ± 3.6 years (range, 6 months to 19 years), 19 of the 99 patients with a preserved aortic valve developed moderate-to-severe aortic insufficiency [19{\%}; 7/68 in G1 (10{\%}) and 12/31 in G2 (39{\%})]. Multivariate analysis revealed that moderate-to-severe preoperative aortic valve insufficiency was a significant risk factor for development of postoperative aortic valve regurgitation (p = 0.008). Reoperation was necessary in 7 G1 patients (10{\%}) and in 8 G2 patients (26{\%}), with an actuarial freedom from reoperation at 5 and 10 years of 93{\%} ± 7{\%} and 80{\%} ± 9{\%} in G1 patients, and 81{\%} ± 8{\%} and 40{\%} ± 15{\%} in G2 patients (p = 0.045). Conclusions. Preservation of the aortic valve and aortic root is recommended in patients with acute type A aortic dissection and absent or mild aortic insufficiency. Patients presenting with moderate-to-severe aortic regurgitation and treated conservatively present an increased risk of recurrent valvular insufficiency.",
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T1 - Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation

AU - Pessotto, Renzo

AU - Santini, Francesco

AU - Pugliese, Peppino

AU - Montalbano, Giuseppe

AU - Luciani, Giovanni Battista

AU - Faggian, Giuseppe

AU - Bertolini, Paolo

AU - Mazzucco, Alessandro

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N2 - Background. The aim of the present study was to verify the efficacy of preserving the aortic valve in patients with acute type A aortic dissection complicated by significant aortic regurgitation. Methods. From January 1979 to December 1996, 178 patients (125 males; mean age 57 ± 9 years) underwent emergency surgery for acute type A aortic dissection, with an overall operative mortality rate of 21%. based on a retrospective analysis of the preoperative angio- or echocardiographic findings, the 141 survivors were divided into 2 groups: Group 1 (G1) included 80 patients (57%) with no or mild aortic regurgitation, and Group 2 (G2) the remaining 61 patients with moderate-to-severe aortic regurgitation. The native aortic valve was preserved by means of a uniform technique consisting of reconstruction of the aortic root and sinotubular junction in 99 patients (70%) [68 in G1 (85%) and 31 in G2 (51%)]. Forty-two patients required aortic valve (8 patients; 6%) or total root replacement (34 patients; 24%). Results. At a mean follow-up of 4 ± 3.6 years (range, 6 months to 19 years), 19 of the 99 patients with a preserved aortic valve developed moderate-to-severe aortic insufficiency [19%; 7/68 in G1 (10%) and 12/31 in G2 (39%)]. Multivariate analysis revealed that moderate-to-severe preoperative aortic valve insufficiency was a significant risk factor for development of postoperative aortic valve regurgitation (p = 0.008). Reoperation was necessary in 7 G1 patients (10%) and in 8 G2 patients (26%), with an actuarial freedom from reoperation at 5 and 10 years of 93% ± 7% and 80% ± 9% in G1 patients, and 81% ± 8% and 40% ± 15% in G2 patients (p = 0.045). Conclusions. Preservation of the aortic valve and aortic root is recommended in patients with acute type A aortic dissection and absent or mild aortic insufficiency. Patients presenting with moderate-to-severe aortic regurgitation and treated conservatively present an increased risk of recurrent valvular insufficiency.

AB - Background. The aim of the present study was to verify the efficacy of preserving the aortic valve in patients with acute type A aortic dissection complicated by significant aortic regurgitation. Methods. From January 1979 to December 1996, 178 patients (125 males; mean age 57 ± 9 years) underwent emergency surgery for acute type A aortic dissection, with an overall operative mortality rate of 21%. based on a retrospective analysis of the preoperative angio- or echocardiographic findings, the 141 survivors were divided into 2 groups: Group 1 (G1) included 80 patients (57%) with no or mild aortic regurgitation, and Group 2 (G2) the remaining 61 patients with moderate-to-severe aortic regurgitation. The native aortic valve was preserved by means of a uniform technique consisting of reconstruction of the aortic root and sinotubular junction in 99 patients (70%) [68 in G1 (85%) and 31 in G2 (51%)]. Forty-two patients required aortic valve (8 patients; 6%) or total root replacement (34 patients; 24%). Results. At a mean follow-up of 4 ± 3.6 years (range, 6 months to 19 years), 19 of the 99 patients with a preserved aortic valve developed moderate-to-severe aortic insufficiency [19%; 7/68 in G1 (10%) and 12/31 in G2 (39%)]. Multivariate analysis revealed that moderate-to-severe preoperative aortic valve insufficiency was a significant risk factor for development of postoperative aortic valve regurgitation (p = 0.008). Reoperation was necessary in 7 G1 patients (10%) and in 8 G2 patients (26%), with an actuarial freedom from reoperation at 5 and 10 years of 93% ± 7% and 80% ± 9% in G1 patients, and 81% ± 8% and 40% ± 15% in G2 patients (p = 0.045). Conclusions. Preservation of the aortic valve and aortic root is recommended in patients with acute type A aortic dissection and absent or mild aortic insufficiency. Patients presenting with moderate-to-severe aortic regurgitation and treated conservatively present an increased risk of recurrent valvular insufficiency.

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