Modified partial aortic root remodeling in acute type A aortic dissection

Abstract

Emergency surgery for acute type A dissection is extremely difficult when the sinuses of Valsalva are widely dissected. Indications for the various proposed surgical approaches are controversial. Here, we describe modified partial aortic root remodeling to overcome bleeding. We retrospectively reviewed 13 consecutive patients who underwent the following operative procedure. We did not resect the sinus but sutured a U-shaped Dacron patch to the inside of the sinus to reinforce the dissected weakened wall. The indications for reconstruction of the aortic root with this technique are extension of an intimal tear into a sinus, a fully dissected sinus as far as the level of the aortic annulus or mild annuloaortic ectasia. One patient died of multiorgan failure. No patient had more than mild aortic regurgitation. Mean follow-up duration was 22 months and there was no late death. Two patients underwent repeated surgery due to graft infection and redissection. Our modified partial aortic root remodeling technique might be a useful surgical procedure if one or two Valsalva sinuses are affected in type A acute aortic dissection.