Comparison And Risk Factors Of Surgical Treatments For The Aortic Root In Acute Aortic Dissection

[Objective]The present study established a single-center clinical database of the surgical treatment for patients with aortic dissection. Based on this basis, the clinical data of patients with acute type A aortic dissection involving the aortic root accompanied by moderate to severe aortic regurgitation undergoing surgical treatment were screened from this database. A retrospective analysis was conducted for two surgical treatments for the aortic root (aortic root remodeling and aortic root replacement) in current acute aortic dissection. Intraoperative conditions, postoperative complications and mortality of the two surgical treatments were compared, so as to evaluate different surgical treatments. Moreover, all patients undergoing aortic root remodeling in the database were further analyzed to explore the risk factors influencing operative mortality,providing reference and basis for future treatment and prognosis of the aortic root in acute A type aortic dissection.[Methods]1. Preliminary work: The establishment of the clinical database of the surgical treatment for patients with aortic dissection, and the screening of subjects;2. The retrospective analysis of 97 patients with acute type A aortic dissection involving the aortic root accompanied by moderate to severe aortic regurgitation undergoing surgical treatment:The clinical data of 97 patients with acute type A aortic dissection involving the aortic root accompanied by moderate to severe aortic regurgitation undergoing surgical treatment, who were continuously treated between January 1, 2014 and May 31, 2016 were screened. According to different intraoperative surgical treatments for the aortic root, the 97 patients were divided into aortic root remodeling group (n = 47) and aortic root replacement (n = 50). Differences in intraoperative and postoperative conditions of the two groups were retrospectively analyzed;3. Analysis of the risk factors of operative mortality in patients with acute A type aortic dissection undergoing aortic root remodeling:The clinical data of a total of 145 patients with acute type A aortic dissection undergoing aortic root remodeling between January 1, 2014 and May 31, 2016 were screened. With survival and death in the duration of hospital stay as endpoint, the patients were divided into survival group and death group to analyze the risk factors influencing operative mortality.[Results ]1. The establishment of data registration form and statistical software for hospitalized patients with aortic dissection: The data included in the database were all patients’data in hospital, mainly including patients’ personal basic information, contact information, incidence, history of past illness, history of cardiovascular surgery,preoperative imaging and laboratory findings, preoperative diagnosis, treatment plan,surgical conditions, conditions in endovascular intervention, postoperative conditions in ICU, and hospital outcomes;2. The retrospective analysis of 97 patients with acute type A aortic dissection involving the aortic root accompanied by moderate to severe aortic regurgitation:Preoperative diameter of the aortic sinus, the degree of aortic regurgitation, and the incidence of postoperative respiratory insufficiency/failure and renal insufficiency in the two groups showed statistical differences (P < 0.05). Comparison in intraoperative mean duration of cardiopulmonary bypass, aortic occlusion and circulatory arrest between the two groups demonstrated no statistical differences (P > 0.05). Among all patients, hospital death occurred in 15 (15.5%) patients, including 9 (19.1%) in the aortic root remodeling group and 6 (12.0%) in the Bentall group, presenting no statistical significance (P = 0.11).3. The analysis of the risk factors of postoperative death in patients with acute A type aortic dissection undergoing aortic root remodeling: Comparison between groups indicated that main variables associated with surgical mortality included duration of hospital stay, chest pain, shock, myocardial ischemia, CK-MB, coagulation function,hepatic insufficiency, platelet, coronary artery dissection, and duration of extracorporeal circulation and aortic occlusion. Using variables with statistical differences shown in univariate analysis,Logistic multivariate regression analysis was carried out, demonstrating that preoperative shock and elevated CK-MB were independent risk factors for operative mortality.[Conclusions]1.In preliminary work, by repeated literature review and discussion, we established a single-center clinical database and information platform of aortic dissection according with our national conditions.2. The intraoperative operation of the aortic root in TAAD patients is complicated, especially in case of emergency. The choice of surgical approach should be integrated into the site of intimal tear, the involving range of aortic dissection, and the quality and structure of aortic valve. In addition, surgeons’ experience, choice of surgical approach and the occurrence of related complications play important roles.Our study demonstrates no statistical difference in perioperative mortality between aortic root remodeling and aortic root replacement. Without the need of postoperative long-term anticoagulation therapy, perioperative risk is lower in aortic root remodeling. Aortic root replacement is the classical treatment of TAAD, with satisfying perioperative outcomes. Mid- and long-term efficacy needs further evaluation by follow-up.3. Although the operative mortality rate of patients with TAAD has been reported to be relatively high, our results show no correlation between operative mortality rate and various intraoperative factors. After admission, rapid and accurate diagnosis,and timely surgical treatment before the occurrence of myocardial ischemia and cardiogenic shock can improve patients’ postoperative survival rate.