Sinus of Valsalva Involvement Affects Aortic Root Growth After Acute Type A Aortic Dissection Repair.

BACKGROUND: Root-preserving repair is commonly used for acute type A aortic dissection without root aneurysm or sinus tears. We evaluated whether the extent of sinus of Valsalva involvement predicts late outcomes and postoperative aortic root growth. METHODS: We conducted a single-center retrospective study of patients undergoing root-preserving acute type A aortic dissection repair with >1 month follow-up and ≥1 postoperative imaging. Fifty patients were included and stratified by sinus of Valsalva involvement (≥2 vs <2 sinus involvement). Primary outcomes were aortic root adverse event-free survival and longitudinal root diameter. RESULTS: Baseline and perioperative characteristics were similar between groups, and no late aorta-related deaths occurred. Aortic root adverse event-free survival was worse with ≥2 sinuses than with <2 (P = .027). At 10 years, the ≥2 sinus involvement group had an estimated mean aortic root diameter of 50.38 mm vs 40.18 mm in the <2 group. The mean root diameter was 10.19 mm larger (95% CI, 4.27-16.11; P = .001) in the ≥2 sinus involvement group at 10 years. CONCLUSIONS: The degree of sinus of Valsalva involvement is associated with postoperative aortic root enlargement and adverse root events after root-preserving repair. In experienced centers, broader use of aortic root replacement, preferably valve-sparing procedures, may be considered for patients with involvement of ≥2 sinuses.