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More long-term root dilation, aortic regurgitation with supracoronary tube implant

17 Jul 2017

Supracoronary tube graft for repair of type A acute aortic dissection (AADA) yields significantly more long-term root dilation and aortic regurgitation, a new study shows. On the other hand, risk of early renal replacement is higher in aortic root replacement.

The group of AADA patients who received supracoronary tube implants had significantly more cases of 2+ aortic regurgitation (29.7 vs 0.0 percent; p=0.006) and more enlarged aortic root (44±6 vs 30±5 mm; p<0.001) than the aortic root replacement group.

On the other hand, total duration of the procedure (457.5±129.9 vs 611.6±197.8 min; p<0.001), cardiopulmonary bypass time (198.4±80.0 vs 316.5±102.5 min; p<0.001) and aortic cross-clamp time (91.6±34.9 vs 191.3±52.8 min; p<0.001) were all significantly longer in the aortic root replacement group than in the supracoronary tube implant group.

Renal failure was also more prevalent in the aortic root replacement group (9.5 vs 0.0 percent; p=0.018).

In terms of short-term outcomes, no between-group difference was found for 30-day mortality (p=0.90), duration of hospital stay (p=0.47), incidence of stroke (p=0.17), length of stay in the ICU (p=0.20), postoperative infections (p=0.48) and dependence on mechanical ventilation (p=0.50).

Survival rates at 1 and 5 years were 71.7 and 67.9 percent, respectively, for the supracoronary tube implant group, and 70.6 and 70.6 percent for the aortic root replacement group. The difference did not reach statistical significance. There was also no difference in terms of reoperation (p>0.99) and cardiac-related deaths (p=0.35) between the groups.

Baseline and follow-up clinical, surgical and imaging information of 75 AADA patients were retrieved and reviewed for the study. Investigators classified the patients according to the procedure received: supracoronary tube implant (n=54) and aortic root replacement (n=21). 

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