The clinical results of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Liangpeng , HUANG Fuhua , SU Cunhua , QIN Wei , QIU Zhibing , JIANG Yingshuo , WANG Liming , XU Ming ,  CHEN Xin

Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing First Hospital, Nanjing Cardiovascular Disease Research Institute, Nanjing, 210006, P.R.China;

Corresponding?author：

CHEN Xin, Email: stevecx@njmu.edu.cn

Keywords：

Partial aortic root remodeling; aortic dissection; aortic valve

DOI：

10.7507/1007-4848.201612030

Video：

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Objective To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods From January 2010 to December 2015, 30 patients (25 males, 5 females) underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling+ascending aortic replacement in 9 patients, partial aortic root remodeling+ascending aortic replacement+hemi-arch replacement in 6 patients, partial aortic root remodeling+ascending aortic replacement+Sun's procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% (29/30). One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation (AI). Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.

Citation： LI Liangpeng, HUANG Fuhua, SU Cunhua, QIN Wei, QIU Zhibing, JIANG Yingshuo, WANG Liming, XU Ming, CHEN Xin. The clinical results of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 506-511. doi: 10.7507/1007-4848.201612030 Copy

1.	Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
2.	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new " standard” therapy fortype a dissection involving repair of the aortic arch?. Circulation, 2011, 123(9): 971-978.
3.	David TE, Armstrong S, Manlhiot C, et al. Long-term results of aortic root repair using the reimplantation technique. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S22-S25.
4.	Sansone F, Zingarelli E, Ceresa F, et al. Partial aortic root remodeling in case of ascending aortic aneurysms. Innovations (Phila), 2013, 8(4): 264-268.
5.	Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg, 2016, 5(4): 275-295.
6.	David TE. Surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 150(2): 279-283.
7.	Tian D, Rahnavardi M, Yan TD. Aortic valve sparing operations in aortic root aneurysms: remodeling or reimplantation?. Ann Cardiothorac Surg, 2013, 2(1): 44-52.
8.	Rahnavardi M, Yan TD, Bannon PG, et al. Aortic valve-sparing operations in aortic root aneurysms: remodeling or reimplantation?. Interact Cardiovasc Thorac Surg, 2011, 13(2):189-197.
9.	Leyh RG, Fischer S, Kallenbach K, et al. High failure rate after valve-sparing aortic root replacement using the "remodeling technique" in acute type A aortic dissection. Circulation, 2002, 106(12 Suppl 1): I229-1233.
10.	David TE. Current readings: Aortic valve-sparing operations. Semin Thorac Cardiovasc Surg, 2014, 26(3): 231-238.
11.	胡振雷, 薛松, 徐根興, 等. 急性主動脈夾層累及根部的外科治療. 中國胸心血管外科臨床雜志, 2012, 19(4): 381-384.
12.	唐楊烽, 徐激斌, 徐志云, 等. Stanford A 型主動脈夾層的根部處理策略及療效分析. 中華外科雜志, 2012, 50(11): 991-994.
13.	Mookhoek A, Korteland NM, Arabkhani B, et al. Bentall procedure: a systematic review and meta-analysis. Ann Thorac Surg, 2016, 101(5): 1684-1689.
14.	秦衛, 黃福華, 陳鑫, 等. 改良 Bentall 手術在 Stanford A 型主動脈夾層治療中的應用. 中國胸心血管外科臨床雜志, 2014, 21(6): 725-729.
15.	Fattouch K, Murana G, Castrovinci S, et al. Outcomes of aortic valve repair according to valve morphology and surgical techniques. Interact Cardiovasc Thorac Surg, 2012, 15(4): 644-650.
16.	陳偉丹, 常謙, 李守軍, 等. 保留主動脈瓣主動脈竇部置換術治療主動脈竇部瘤的療效分析. 中國胸心血管外科臨床雜志, 2012, 19(5): 498-501.
17.	Yunoki J, Nakayama Y, Oonishi H, et al. Partial aortic root remodeling with an adventitial inversion technique for an acute type a aortic dissection. J Card Surg, 2010, 25(3): 327-329.

1. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
2. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new " standard” therapy fortype a dissection involving repair of the aortic arch?. Circulation, 2011, 123(9): 971-978.
3. David TE, Armstrong S, Manlhiot C, et al. Long-term results of aortic root repair using the reimplantation technique. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S22-S25.
4. Sansone F, Zingarelli E, Ceresa F, et al. Partial aortic root remodeling in case of ascending aortic aneurysms. Innovations (Phila), 2013, 8(4): 264-268.
5. Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg, 2016, 5(4): 275-295.
6. David TE. Surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 150(2): 279-283.
7. Tian D, Rahnavardi M, Yan TD. Aortic valve sparing operations in aortic root aneurysms: remodeling or reimplantation?. Ann Cardiothorac Surg, 2013, 2(1): 44-52.
8. Rahnavardi M, Yan TD, Bannon PG, et al. Aortic valve-sparing operations in aortic root aneurysms: remodeling or reimplantation?. Interact Cardiovasc Thorac Surg, 2011, 13(2):189-197.
9. Leyh RG, Fischer S, Kallenbach K, et al. High failure rate after valve-sparing aortic root replacement using the "remodeling technique" in acute type A aortic dissection. Circulation, 2002, 106(12 Suppl 1): I229-1233.
10. David TE. Current readings: Aortic valve-sparing operations. Semin Thorac Cardiovasc Surg, 2014, 26(3): 231-238.
11. 胡振雷, 薛松, 徐根興, 等. 急性主動脈夾層累及根部的外科治療. 中國胸心血管外科臨床雜志, 2012, 19(4): 381-384.
12. 唐楊烽, 徐激斌, 徐志云, 等. Stanford A 型主動脈夾層的根部處理策略及療效分析. 中華外科雜志, 2012, 50(11): 991-994.
13. Mookhoek A, Korteland NM, Arabkhani B, et al. Bentall procedure: a systematic review and meta-analysis. Ann Thorac Surg, 2016, 101(5): 1684-1689.
14. 秦衛, 黃福華, 陳鑫, 等. 改良 Bentall 手術在 Stanford A 型主動脈夾層治療中的應用. 中國胸心血管外科臨床雜志, 2014, 21(6): 725-729.
15. Fattouch K, Murana G, Castrovinci S, et al. Outcomes of aortic valve repair according to valve morphology and surgical techniques. Interact Cardiovasc Thorac Surg, 2012, 15(4): 644-650.
16. 陳偉丹, 常謙, 李守軍, 等. 保留主動脈瓣主動脈竇部置換術治療主動脈竇部瘤的療效分析. 中國胸心血管外科臨床雜志, 2012, 19(5): 498-501.
17. Yunoki J, Nakayama Y, Oonishi H, et al. Partial aortic root remodeling with an adventitial inversion technique for an acute type a aortic dissection. J Card Surg, 2010, 25(3): 327-329.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The clinical results of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection

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