Patch neointima technique in acute type A aortic dissection: mid-term results of 147 cases.

Abstract Background Patch neointima technique is a modified valve-sparing aortic root repair surgery for acute type A aortic dissection and the short-term outcomes are satisfactory. The mid-term outcomes have not been reported. Methods From January 2009 to December 2012, 147 patients underwent valve-sparing aortic root repair with the patch neointima technique for type A aortic dissection in our center. The mid-term outcomes of the patients were evaluated by echocardiography and aortic computed tomography angiography (CTA). Results Of 147 patients, 32 patients (21.8%) underwent proximal arch repair, and 115patients (78.2% ) underwent proximal arch repair combined with triple-branched stent graft implantation. The perioperative mortality was 5.4%. Preoperative aortic insufficiency (AI) was observed in 94 patients (63.9%); 131 patients(89.1%) left the operating room with 0 AI; the remaining 16 patients (10.9%) had trace or less than 1+ AI. A total of 128 patients (87.1%) completed 7-year follow-up. The mean follow-up time was 5.7 + 1.2 years. Up to 82.0% of the patients (105) were 0 AI and 15.6 % of the patients (20) were 0.5+ trace or less than 1+ AI. No reoperation was performed for the aortic root. The diameters of sinotubular junction and sinus were reduced to the normal range (28.3 + 4.2mm and 30.5 + 3.6mm respectively) and remained stable (28.9 + 5.6mm, p=0.300 and 30.8 + 4.2mm, p=0.540, respectively) during 7 years’ follow up. Conclusions Valve-sparing aortic root repair with patch neointima technique was associated with stable function of the aortic valves and no expansion of the aortic root in the mid-term.