Does adding a Root Replacement in Type A Aortic Dissection Repair
Provide Better Outcomes?
Abstract
Background: Acute type A aortic dissection (ATAAD), is a surgical
emergency often requiring intervention on the aortic root. There is much
controversy regarding root management; aggressively pursuing a root
replacement, versus more conservative approaches to preserve native
structures. Methods: Electronic database search we performed through
PubMed, Embase, SCOPUS, google scholar and Cochrane identifying studies
that reported on outcomes of surgical repair of ATAAD through either
root preservation or replacement. The identified articles focused on
short- and long-term mortalities, and rates of re-operation on the
aortic root. Results: There remains controversy on replacing or
preserving aortic root in ATAAD. Current evidence supports practice of
both trends following an extensive decision-making framework, with
conflicting series suggesting favourable results with both procedures as
the approach that best defines higher survival rates and lower
perioperative complications. Yet, the decision to perform either
approach remains surgeon decision and bound to the extent of the
dissection and tear entries in strong correlation with status of the
aortic valve and involvement of coronaries in the dissection.
Conclusions: There exists much controversy regarding fate of the aortic
root in ATAAD. There are conflicting studies for impact of root
replacement on mortality, whilst some study’s report no significant
results at all. There is strong evidence regarding risk of re-operation
being greater when root is not replaced. Majority of these studies are
limited by the single centred, retrospective nature of these small
sample sized cohorts, further hindered by potential of treatment bias.