Preservation of the aortic valve in acute aortic dissection : long-term echocardiographic assessment and clinical outcome

Abstract The aim of the present study was to determine the long-term status of the native aortic valve after surgical treatment of acute aortic dissection involving the ascending aorta. From 1972 to 1991, 93 patients underwent operation for type I or II aortic dissection. There were 76 men and 17 women. Mean age was 54 ± 13 years. Eighty patients (86%) had a conservative procedure regarding the aortic root and aortic cusps: 74 had prosthetic replacement of the ascending aorta and 6, complete replacement of the aortic arch. Thirteen patients (14%) had simultaneous replacement of the aortic valve and the ascending aorta. The overall hospital mortality rate was 29% (27/93). The overall actuarial survival rate was 60.2% ± 5.2%, 49.7% ± 6.1%, and 35.9% ± 8.1% at 5, 10, and 15 years, respectively. The survival rates for patients who had an ascending aortic procedure only were 63% ± 5.5%, 54% ± 6.5%, and 39% ± 8.5% at 5, 10, and 15 years, respectively, and for patients who required aortic valve replacement, 45% ± 14% and 22% ± 17.5% at 5 and 10 years, respectively. Fifty long-term survivors (94% follow-up) with preservation of the aortic valve and aortic root were studied. Among them, 9 (18%) died within a mean interval of 97 ± 46 months after operation. Causes of death were ischemic cardiac failure (2), aortic rupture or extension of dissection (4), renal disease (1), stroke (1), and sudden death (1). Forty-one patients had long-term clinical and echocardiographic evaluation. Severe aortic insufficiency developed in 7 patients in the years after operation, and 6 of them underwent reoperation for prosthetic valve replacement. Echocardiographic findings were judged to show no or mild residual aortic insufficiency in 22 patients and moderate aortic insufficiency with satisfactory left ventricular function in 12 (2 patients had aortic valve replacement because of concomitant mitral valve disease or coronary disease). In all, late aortic valve replacement was realized in 8 patients at a mean interval of 61.5 ± 51.2 months after the first operation. Actuarial freedom from aortic valve replacement was 83% ± 6% at 5 years and 79% ± 7% at 10 and 15 years. This study emphasizes the benefit of surgical procedures that preserve the aortic valve and aortic root in the repair of acute aortic dissection involving the ascending aorta, without additional risk of recurrent aortic insufficiency.