Long-Term Results of Neomedia Sinus Valsalva Repair in 489 Patients With Type A Aortic Dissection

Background. Acute type A aortic dissection frequently occurs in patients with normally sized aortic roots. The aim of this investigation was to describe the durability of aortic valve resuspension and root repair with a novel technique of reconstruction in type A dissection. Methods. From 1993 to 2013, among 629 patients operated on for acute type A dissection 489 (62% male, median age 62 years (53; 73) underwent aortic valve resuspension and reinforcement of the sinus of Valsalva with a Teflon felt neomedia. The median follow-up time was 4.1 years (1.3; 6.8) (2075 patient-years). Results. In-hospital mortality was 11% (56/489). Survival was 69% +/- 2%, 50% +/- 3%, and 36% +/- 5% at 5, 10, and 15 years, respectively. Freedom from moderate or severe aortic regurgitation was not influenced by the aortic regurgitation grade at the initial operation (p = 0.131). Freedom from proximal aortic reoperation was 96% +/- 1%, 92% +/- 2%, and 89% +/- 4% at 5, 10, and 15 years, respectively. Seventeen patients (3%) required proximal reoperation: 10 for aortic regurgitation, including 3 with concomitant pseudoaneurysm and 2 with root aneurysm; 6 for pseudoaneurysm; and 1 for graft infection. Conclusions. Aortic root neomedia reconstruction and valve resuspension can be successfully performed in the majority of patients with type A dissection. The inhospital mortality is low, and the results are durable. (C) 2014 by The Society of Thoracic Surgeons