Porto Alizee, Court Axel, Barral Pierre Antoine, Boucekine Mohamed, Imbert Laura, Gariboldi Vlad, Jacquier Alexis, Collart Frederic, Theron Alexis, Gaudry Marine
Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France.
Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France.
J Clin Med. 2025 Sep 5;14(17):6274. doi: 10.3390/jcm14176274.
The management of the aortic root in type A aortic dissection (TAAD) is challenging. Conservative aortic root repair is considered a reasonable option in most cases. This study aimed to analyze medium-term mortality and aortic root reintervention after TAAD. All patients with TAAD underwent prospective follow-ups between 2017 and 2021. The primary endpoint was the increase in aortic root diameter and the rate of proximal root reintervention. The secondary endpoints were the risk factor and location for root-RAD, and risk factors for severe and moderate AR and mortality during follow-up. A total of 210 patients were included, of which 166 (79.0%) did not have root-RAD and 44 (21.0%) had root-RAD after supracoronary aortic replacement. After a mean follow-up of 41.1 months (0-60), four patients (1.8%) died. No cases of aortic root rupture were reported. Two patients in the root-RAD group underwent aortic root reoperation. The aortic root diameter increased by 0.5 mm/year and 0.09 mm/year in the root-RAD and no-root-RAD groups, respectively ( = 0.18). Root-RAD was a risk factor for severe AR (HR 19.6; 95%CI: 1.6-2.7; = 0.05) and an independent risk factor for moderate AR (HR 23.0; 95%CI: 2.8-2.9; = 0.009). Without increasing long-term mortality, root-RAD increases the risks of AR and subsequent aortic root reintervention. Long-term follow-up is essential for monitoring aortic valve function.
A型主动脉夹层（TAAD）中主动脉根部的管理具有挑战性。在大多数情况下，保守的主动脉根部修复被认为是一种合理的选择。本研究旨在分析TAAD后的中期死亡率和主动脉根部再次干预情况。所有TAAD患者在2017年至2021年期间接受了前瞻性随访。主要终点是主动脉根部直径的增加和近端根部再次干预的发生率。次要终点是根部-RAD的危险因素和位置，以及随访期间严重和中度AR的危险因素和死亡率。共纳入210例患者，其中166例（79.0%）在冠状动脉上主动脉置换术后没有根部-RAD，44例（21.0%）有根部-RAD。平均随访41.1个月（0-60个月）后，4例患者（1.8%）死亡。未报告主动脉根部破裂病例。根部-RAD组中有2例患者接受了主动脉根部再次手术。根部-RAD组和无根部-RAD组的主动脉根部直径分别以每年0.5 mm和每年0.09 mm的速度增加（P = 0.18）。根部-RAD是严重AR的危险因素（HR 19.6；95%CI：1.6-2.7；P = 0.05），也是中度AR的独立危险因素（HR 23.0；95%CI：2.8-2.9；P = 0.009）。根部-RAD在不增加长期死亡率的情况下，增加了AR和随后主动脉根部再次干预的风险。长期随访对于监测主动脉瓣功能至关重要。
