INTRODUCTION
The primary aim of surgery for acute type A aortic dissection (TAAD) is the prevention of death from aortic rupture, which is mainly accomplished by excision of the proximal intimal tear, supra-coronary ascending aorta replacement and re-establishment of dominant flow in the distal true lumen(1–3). Ensuring a competent aortic valve is an equally vital goal of surgery, although the methods of how to address this is a matter of debate.
The decision to replace the aortic root depends on the proximal extent of the dissection flap, degree of aortic regurgitation and the surgeon’s choice. The operative strategies can be broadly divided between a conservative root repair and a complete root replacement with re-implantation of coronaries. Specifically, the variations in management include: i) interposition graft only; ii) interposition graft with aortic valve resuspension(4); iii) interposition graft with aortic valve replacement; iv) valve sparing root replacement(5,6); or v) root replacement with a valve-graft composite (first described by Bentall and De Bono)(7). Aortic root replacement (ARR) has most commonly involved mechanical composite valve grafts (CVG), which have excellent durability but necessitate lifelong anticoagulation(8).
The rationale for stentless aortic valve replacement was born out of the pioneering use of homografts and pulmonary autografts over the last few decades. Acceptable valve durability and improved valve haemodynamics compared to stentless valves were important characteristics that stimulated continued uptake of stentless technology(9,10). Stentless porcine aortic roots (PAR) also have an established role in clinical practice, primarily in the treatment of aortic valve disease and proximal aortopathy, although their use in TAAD is less well characterised in the literature.
This study aims to compare the outcomes between PAR and CVG in patients undergoing aortic root replacement for acute TAAD.