Preoperative Risk Factors for Residual Aortic Regurgitation after Valve Re-Suspension Procedure in Acute Type A Aortic Dissection

(Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka, Japan)

Tsutomu Sugimoto Kazuo Yamamoto Shinpei Yoshii
Satoshi Tanaka Norihiko Saito Chizuo Kikuchi
Kenji Aoki Atsushi Kuwabara Shigetaka Kasuya
This study evaluated factors influencing residual aortic regurgitation (AR) after valve re-suspension surgery for acute type A aortic dissection. From January 1996 through December 2002, 63 patients were treated for acute type A dissection at our institution. Among these 63 patients, pre-and postoperative echocardiograms were available in 38 patients who underwent surgery combined with native aortic valve re-suspension. These 38 patients were divided into 2 groups according to the postoperative AR grade, i.e.: AR group: AR grade†‡U (n6), no-AR group: AR grade…‡T (n32). The severity of pre and postoperative AR was assessed by transthoracic or transesophageal echocardiography. The preoperative diameters of mid ascending aorta and sinotubular junction, and the percentage of the circumference of the dissection at the sinotubular junction level was measured by enhanced CT scan. Preoperative patient backgrounds were similar in both groups. The preoperative AR grade in the AR group was significantly greater than that of the no-AR group (2.25}1.17: 0.69}0.91, pƒ0.001). The tear was more frequently located in the ascending aorta in the AR group than in the no-AR group (66.7%: 37.5%, pƒ0.05). The percentage of circumference of the dissection at the sinotubular junction level did not affect the preoperative AR grade, but it did show a tendency to influence the severity of postoperative AR, though the difference was not significant. Three patients (7.9%) had AR grade ‡V at the time of discharge, but did not clinically require further surgical intervention. Preoperative significant AR and the location of the tear in the ascending aorta are associated with postoperative residual AR after aortic valve re-suspension. The percentage of circumference of the dissection at the sinotubular junction level might influence the severity of postoperative AR.
@Jpn. J. Cardiovasc. Surg. 34: 93-97 (2005)