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Aortic Root Remodeling With External Aortic Annuloplasty In The Treatment Of Acute Type A Aortic Dissection: Short Term Results
Olivier Bouchot, Marie Catherine Morgant, Ghislain Malapert, Roger Brenot.
University Hospital, Dijon, France.

Aims: To evaluate the management of acute type A aortic dissection by aortic root remodeling associated with external aortic annuloplasty (ARREAA). Methods: Between June 2010 and August 2013, sixteen patients underwent root aortic remodeling and aortic ring annuloplasty in surgical treatment of type A aortic dissection . Results: Twelve were male, the mean age was 62.3 ± 10.8 years. Twelve patients were operated on in an emergency situation, two in salvage, and 2 after a few days of delay. Seven patients had preoperative malperfusion (5 had a neurologic signs and 2 an acute ischemia of the lower limbs). The ARREAA procedure was associated with a hemi arch replacement in thirty patients under moderate hypothermia (28 ± 2.4°C) and selective cerebral anterograde perfusion. A Valsalva graft (Vascutek) was used in all patients (diameter 24 mm : 1 pts; 26mm : 4 pts; 28mm : 7; 30mm: 2pts). The external aortic annuloplasty used was a dacron ring in 6 patients (diameter 26 mm: 1pt; 28 mm: 5 pts) and an Extraortic ring (Coroneo) in 10 patients (diameter 25 mm: 5 pts; 27 mm: 3 pts; 29 mm: 2pts). Aortic clamping and cardiopulmonary bypass times were respectively 173 ± 38.9 min and 211 ± 53 min. The distal circulatory arrest was 30 ± 11.7 min. Two patients needed a bypass graft on the right coronary artery. Mean bleeding at 24h and 48h were 1021 ± 651 ml and 1394 ± 808 ml. Median intubation time was 18.5 hours. Two patients had prolonged ventilation (11.6 and 46 days). Nine patients presented kidney failure in perioperatoire, but only four required transitory dialysis in Intensive Care Unit (ICU). Two patients needed ECLS for heart failure. Another patient, at day 17, had a coronary artery bypass on LAD. One patient who was operated on in salvage conditions died postoperatively (cerebral ischemia) two days later. At discharge only one patient had moderate aortic insufficiency. Conclusion: Aortic root remodeling with external aortic annuloplasty in the surgical treatment of acute type A aortic dissection is feasible with good results for aortic valve sparing.

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