Funding declarations: None to be declared
Keywords: Outcomes, Aorta, Dissection, Root, Survival
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.