What are the results of VSRRR in TAAAD?
We reported our institutional series of 43 patients who had reimplantation for TAAAD. The mean age was 46 years-of-age, > 50% of the patients had 3+AI, 9% had EF ≤ 35%, and 90% had concomitant hemiarch repair. Our perioperative mortality was 5% with renal failure requiring dialysis and a similar stroke rate. Freedom from 2+AI was 94% and none of the patients required aortic valve replacement during follow-up. Our selection criteria outlines earlier translated in performing VSRR in approximately 10% of patients presenting with TAAAD; which highlights the importance of patients’ selection(25). Seiver’s group performed VSRR in over a third of patients referred with TAAAD. In their series of 20 over 6 years, 11 patients had remodelling and 9 had reimplantation. The mortality was 10% with no reoperations(27).
In a study by Wayne State University group of VSRR in 135 patients with TAAAD; the mortality was 9.5% for the cohort with reoperations in 0% and 2% in the VSRR and Bentall respectively. The long-term survival was better in the VSRR group, which may be explained by the fact that the VSRR group was younger. The important finding of their study that with appropriate patient selection VSRR can be performed safely in patients with TAAAD(22). A propensity-matched study of VSRRR Vs Bentall by our group demonstrated an improved long-term survival in patients treated with VRRR(28). Hannover group reported a mortality of 11% in patients with TAAAD following VSRR, with a freedom from reoperation of 85% at 10 years(24).
It is likely that a selection bias in patients who had VSRRR exists together with reporting bias of experienced centres results in the literature. However, it is no unreasonable to conclude that in selected patients VSRRR has favourable outcome in comparison with composite valve conduit aortic root replacement.