| Preoperative Risk Factors for
Residual Aortic Regurgitation after Valve Re-Suspension Procedure
in Acute Type A Aortic Dissection |
(Department of Cardiovascular Surgery, Tachikawa
Medical Center, Nagaoka, Japan)
| Tsutomu Sugimoto |
Kazuo Yamamoto |
Shinpei Yoshii |
| Satoshi Tanaka |
Norihiko Saito |
Chizuo Kikuchi |
| Kenji Aoki |
Atsushi Kuwabara |
Shigetaka Kasuya |
|
This study evaluated factors influencing
residual aortic regurgitation (AR) after valve re-suspension
surgery for acute type A aortic dissection. From January 1996
through December 2002, 63 patients were treated for acute type
A dissection at our institution. Among these 63 patients, pre-and
postoperative echocardiograms were available in 38 patients who
underwent surgery combined with native aortic valve re-suspension.
These 38 patients were divided into 2 groups according to the
postoperative AR grade, i.e.: AR group: AR gradeU (n6), no-AR
group: AR grade
T (n32). The severity of pre and postoperative
AR was assessed by transthoracic or transesophageal echocardiography.
The preoperative diameters of mid ascending aorta and sinotubular
junction, and the percentage of the circumference of the dissection
at the sinotubular junction level was measured by enhanced CT
scan. Preoperative patient backgrounds were similar in both groups.
The preoperative AR grade in the AR group was significantly greater
than that of the no-AR group (2.25}1.17: 0.69}0.91, p0.001).
The tear was more frequently located in the ascending aorta in
the AR group than in the no-AR group (66.7%: 37.5%, p0.05).
The percentage of circumference of the dissection at the sinotubular
junction level did not affect the preoperative AR grade, but
it did show a tendency to influence the severity of postoperative
AR, though the difference was not significant. Three patients
(7.9%) had AR grade V at the time of discharge, but did not clinically
require further surgical intervention. Preoperative significant
AR and the location of the tear in the ascending aorta are associated
with postoperative residual AR after aortic valve re-suspension.
The percentage of circumference of the dissection at the sinotubular
junction level might influence the severity of postoperative
AR.
@Jpn. J. Cardiovasc. Surg. 34: 93-97 (2005) |
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