Early and Short-term Outcomes of Adopting Aortic Valve Re-Implantation Technique Addressing DeBakey Type 1 Aortic Dissection

Abstract

Background: Acute aortic dissection is a critical medical condition that has a significant risk of death and morbidity. The Bentall  procedure has become the accepted standard for treating aortic root pathology. The newer trend is to perform the aortic valve-sparing  operations to prevent various risks related to prosthetic valves. Objective: This study primarily aimed at assessment of the early and  short-term results of adopting aortic valve re-implantation technique (Tirone David) addressing DeBakey Type 1 aortic dissection  including cardiac function assessment, major cardiac problems, clinical status, quality of life and mortality over 1-year follow-up.

Patients  and Methods: This retrospective study included 49 patients with acute aortic dissection DeBakeytype 1 associated with severe  aortic incompetence (AI), intramural hematoma involving the ascending aorta and/or penetrating atherosclerotic ulcer in the ascending  aorta. They were operated upon using aortic valve re-implantation technique (Tirone David).

Results: The mean age was 54.15±13.77  years. Mortality was 0% intraoperatively, 5(10.20%) operative mortality, no late mortality and the overall 1-year survival rate was  44(89.80%). The overall hospital complications rate was13 (26.53%). At 1-year follow-up, there were statistically significant improvements in left ventricular ejection fraction per cent (LVEF%), left ventricular end-diastolic diameter (LVEDD)(p<0.001), left ventricular end-systolic  diameter (LVESD) (p<0.001) and AI degree. LVEF improved from 52.54±9.16% preoperatively to 55.67±8.35% (p=0.015). AI degree improved  from severe AI in 100% of cases to no or trivial AI in 28(63.63%) patients, mild AI in 15(34.09%) patients, moderate AI in  1(2.27%) patient and no patients with severe AI (p<0.001). There were no complications in the form of aortic valve (AV) failure.  

Conclusion: The procedure of preservation of the patient’s native aortic valve through re-implantation technique (Tirone David  operation), when appropriate, is recommended as it allows better left ventricular performance and avoiding the development of valve- related complications (endocarditis, thromboembolic complications and life-long anticoagulation).