Aortic Root Repair Using Pericardial Autograft For Acute Type A Aortic Dissection:a Retrospective Cohort Study

BackgroundAcute Stanford type A aortic dissection(ATAAD)features acute onset,severe condition and high mortality.Once diagnosed,emergency operation is indispensable.It is difficult to treat aortic dissection for surgeons when aortic sinus is impaired,resulting in avulsion of aortic valve junctions and involvement of coronary ostia.Various aortic root repair techniques are used including the sandwich technique and the modified sandwich technique,biological glue,adventitial inversion technique,neo-media technique and direct suture.Aortic root repair using pericardial autograft is a new method which is expected to reduce the risk of peri-operation bleeding and reinforce impaired aortic sinus.This research aims to retrospectively analysis patients with ATAAD underwent surgical repair using this method in Beijing,Shenzhen and Yunnan Fuwai hospital in recent 5 years,and compare the intraoperative and early postoperative outcomes of aortic root repair using pericardial autograft technique with that of direct suture.Besides,the purpose of this research is to evaluate the short-term outcomes following aortic root repair using pericardial autograft in patients with ATAAD.MethodsBetween 2017.7 and 2022.8,95 consecutive patients with ATAAD underwent aortic root repair by the same surgeon in Beijing,Shenzhen and Yunnan Fuwai hospital,including aortic root repair using pericardial autograft(group A,n=49)or direct suture(group B,n=46).All of them had impaired aortic sinus with diameter no more than 45mm.The preoperative,intraoperative and early postoperative variables were analyzed and compared in both groups.The variables were described by mean and standard deviation for normally distributed continuous variables,median and interquartile spacing for non-normally distributed continuous variables,and frequency and composition ratios for categorical variables.The preoperative,intraoperative and early postoperative aortic valve insufficiency and aortic sinus diameter of the two groups were pairwise compared and Kruskal-Wallis test was used for comparison between the two groups.The primary endpoint events were defined as in-hospital mortality,re-cardiopulmonary bypass for hemostasis and reoperation for hemostasis.Logistic regression model was used for multivariate regression analysis of primary endpoint events.The dependent variables were the primary endpoint events,while the independent variables included surgical technique,age,gender,preoperative serum creatinine,pre-operative aortic valve insufficiency,avulsion of aortic valve junctions and involvement of coronary ostia.ResultsThere was no significant difference in the overall preoperative characteristics between the two groups.In patients underwent aortic root repair using pericardial autograft(group A),in-hospital mortality,reoperation,reoperation for hemostasis,new-onset renal failure required continuous renal replacement therapy,stroke and paraplegia occurred in 0%,6%,2%,10%,6%and 2%of them,respectively.Otherwise,in patients underwent direct suture(group B),in-hospital mortality,reoperation,reoperation for hemostasis,new-onset renal failure required continuous renal replacement therapy,stroke and paraplegia occurred in 2%,15%,7%,11%,4%and 2%of them,respectively.There was no difference in the inhospital mortality and complication rate between the two groups.Logistic regression analysis indicated that there was a significant correlation between the primary endpoint events and surgical technique(OR,0.002;95%CI,0-0.159;P=0.026),suggesting that the group A tended to reduce in-hospital mortality and have the lower risk of recardiopulmonary bypass for hemostasis and reoperation for hemostasis.After operation,the aortic valve sufficiency of the two groups were improved significantly,(group A,P<0.001;group B,P<0.001;respectively),indicating that both of surgical techniques could suspend aortic valve junctions and restore the physiological function of aortic valves effectively.Besides,the aortic sinus diameter was reduced significantly after operation(group A,P<0.001;group B,P=0.002;respectively).There was no significant difference in terms of postoperative serum creatinine and alanine aminotransferase(ALT).During follow-up,the mortality of group A was 6.1%(3/49),whereas the mortality of group B was 6.7%(3/45).Both of groups were free from residual or recurrent aortic dissection and free from reoperation for aortic disease.There was no significant difference in postoperative short-term survival between the two groups(P=0.93).ConclusionsPatients underwent aortic root repair using pericardial autograft tended to reduce inhospital mortality and have the lower risk of re-cardiopulmonary bypass for hemostasis and reoperation for hemostasis,indicating that this surgical technique could providing leak-proof anastomosis through suturing pericardial autograft patch with aortic adventitia.Besides,it could suspend aortic valve junctions and reduce the aortic sinus diameter effectively.Therefore,aortic root repair using pericardial autograft is safe and effective for patients with ATAAD and has satisfactory short-term outcome.