101AORTIC VALVE REPAIR IN ACUTE TYPE A AORTIC DISSECTION

• Published in: Interactive cardiovascular and thoracic surgery 2013-10, Vol.17 (suppl_2), p.S93-S93
• Main Authors: Saczkowski, R., Malas, T., El Khoury, G., Mesana, T., Boodhwani, M.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt372.101

Objectives: Repair and preservation of the aortic valve (AV) in type A aortic dissection remains controversial. We performed a meta-analysis of outcomes for AV repair and preservation in acute type A aortic dissection focusing on long-term valve-related events. Methods: Structured searches were performed in Embase (1980-2012) and PubMed (1966-2012) for studies reporting AV repair or preservation in acute type A aortic dissection. Early mortality and linearized rates for late mortality and valve-related events were derived. Outcome data were pooled with an inverse-variance weighted random-effects model. Results: Of 5325 screened articles, 19 observational studies met eligibility criteria, consisting of 2402 patients with a median follow-up of 4.1 years (range 3.1-12.6, total 13 733 patient-years). The cohort was principally male (median = 68.1%, 39-89) with a median age of 59 years (range 55-68) and Marfan syndrome was present in 2.5%. AV resuspension was performed in 85% and the remainder underwent valve-sparing root replacement. Pooled early and late mortality were 18.7% (CI 12.2-26.2), and 4.7%/patient-year (CI 3.3-6.4), respectively. Linearized rate for AV reintervention was 2.8%/patient-year (CI 1.5-4.4), recurrent AI (>2+) was 4.6%/patient-year (CI 3.1-6.2), and endocarditis was 0.5%/patient-year (CI 0.08-1.3). The composite rate of thromboembolism and bleeding was 1.4%/patient-year (CI 0.7-2.3). Conclusions: Repair of acute type A aortic dissection is associated with poor long-term survival. Preservation and repair of the aortic valve is associated with a moderate risk of reoperation and recurrent AI and a low risk of thromboembolism, bleeding, and endocarditis.