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.