Limitations
Despite the strength of its findings, this study also has some
limitations to consider. It reflects the experience of only two centres
treating ATAAD and therefore only a limited number of surgeons. Despite
the moderate sample size, the key conclusions relating to death and
recurrence are based on outcomes with a small event rate, thus limiting
the certainty of conclusions on performance of the native aortic valve
after resuspension. Additionally, as with all studies reporting
long-term outcomes, some patients were lost to follow-up (20%), most
frequently due to patient care being continued away from the tertiary
centres, which reflects the reality of patient management for such a
complex disease. Furthermore, follow up of aortic root dimensions in the
AAG cohort was based entirely on echocardiographic analysis rather than
the gold standard cross sectional imaging. Future studies in larger
groups using CT follow-up for aortic root dimensions would provide
clearer conclusions on this topic.