Five-year durability of aortic root preservation in type A aortic dissection: A single centre experience in 1,333 patients

OBJECTIVE: To evaluate the mid-term outcomes of aortic root preservation in patients with acute type A aortic dissection (ATAAD) and significant preoperative aortic regurgitation (AR). METHODS: The study included patients who underwent surgical repair for ATAAD with aortic root preservation from 2005 to 2024. Root preservation was preferred unless limited by severely damaged root intima, significant AR with cusp lesions, dilated sinus, or connective tissue disorder. Patients were stratified into an AR group (moderate or severe AR) and a non-AR group (less than moderate AR). Primary outcomes included overall survival and freedom from recurrent AR. RESULTS: Totally 1,333 patients were included into AR group (n = 369) and non-AR group (n = 964). Overall 30-day mortality was 11.3% (15.2% AR group vs 9.9% non-AR group; P = .006); however, preoperative AR was not associated with early mortality after multivariate adjustment. Overall survival at 10 years was comparable between groups (93.6% vs 92.3%). Freedom from recurrent AR at 10 years was 88% in the AR group compared to 97.1% in the non-AR group (P < .001). In multivariable analysis, intraoperative residual mild AR (Hazard ratio [HR] 4.08, P = .001) and connective tissue disorders (HR 4.36, P = .018) were the strongest predictors of recurrence. Without presence of intraoperative residual mild AR, preoperative moderate/severe AR did not increase risk or late recurrence. CONCLUSIONS: Aortic root preservation demonstrated satisfactory mid-term outcomes and may represent a safe and durable strategy for ATAAD with significant preoperative AR. Intraoperative residual mild AR increases risk of recurrence, warranting closer monitoring.