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.