loading page

Aortic root replacement to treat type A aortic dissection: a comparison of mid-term outcomes between composite-valve-grafts and porcine aortic roots
  • +5
  • Mohammad Salmasi,
  • Abinash Panda,
  • Philip Hartley,
  • Ashiq Abdulkhader,
  • Ahmed Osman,
  • CHRISTOPH NIENABER,
  • Thanos Athanasiou,
  • GEORGE ASIMAKOPOULOS
Mohammad Salmasi
Imperial College London
Author Profile
Abinash Panda
Royal Brompton and Harefield NHS Trust
Author Profile
Philip Hartley
Royal Brompton and Harefield NHS Trust
Author Profile
Ashiq Abdulkhader
Imperial College London
Author Profile
Ahmed Osman
Royal Brompton and Harefield NHS Trust
Author Profile
CHRISTOPH NIENABER
Royal Brompton Hospital
Author Profile
Thanos Athanasiou
Imperial College London
Author Profile
GEORGE ASIMAKOPOULOS
Royal Brompton Hospital
Author Profile

Abstract

Background Porcine aortic roots (PAR) have been reported in the literature with acceptable short and long-term outcomes for the treatment of aortic root aneurysms. However, their efficacy in type A aortic dissection (TAAD) is yet to be defined. Methods Using data from a locally collated aortic dissection registry, we compared the outcomes in patients undergoing aortic root replacement for TAAD using either of two surgical options: i) PAR or ii) composite valve grafts (CVG). A retrospective analysis was conducted for all procedures in the period 2005-2018. Results A total of 252 patients underwent procedures for TAAD in the time period. Sixty-five patients had aortic root replacements (PAR n=30, CVG n=35). Between group comparisons identified a younger CVG group (50.5 vs 64.5, p<0.05) although all other covariates were comparable. Operative parameters were comparable between the two groups. The use of PAR did not significantly impact operative mortality (OR 0.93, 95% CI 0.22-3.61, p=0.992), stroke (OR 2.91, 0.25 – 34.09, p=0.395), re-operation (OR 0.91, 95% CI 0.22 – 3.62, p=0.882) or length of stay (coef 2.33, -8.23 – 12.90, p=0.659) compared to CVG. Five-year survival was similar between both groups (PAR 59% vs CVG 69%, p=0.153) and re-operation was negligible. Echocardiography revealed significantly lower aortic valve gradients in the PAR group (8.69 vs 15.45 mmHg, p<0.0001), and smaller left ventricular dimensions both at 6 weeks and 1 year follow up (p<0.05). Conclusions This study highlights the comparable short and mid-term outcomes of PAR in cases of TAAD, in comparison to established therapy.

Peer review status:ACCEPTED

10 Apr 2020Submitted to Journal of Cardiac Surgery
13 Apr 2020Submission Checks Completed
13 Apr 2020Assigned to Editor
14 Apr 2020Reviewer(s) Assigned
05 May 2020Review(s) Completed, Editorial Evaluation Pending
05 May 2020Editorial Decision: Revise Major
22 May 20201st Revision Received
23 May 2020Submission Checks Completed
23 May 2020Assigned to Editor
23 May 2020Reviewer(s) Assigned
23 May 2020Review(s) Completed, Editorial Evaluation Pending
23 May 2020Editorial Decision: Accept