DOI: 10.25881/BPNMSC.2018.67.91.004


Gordeev M.L., Uspenskij V.E., Kim G.I., Kucherenko V.S., Najmushin A.V., Fokin V.A., Mitrofanova L.B., Moiseeva O.M.

Almazov National Medical Research Centre, Ministry of Health Care of Russian Federation.


153 patients with a diagnosis of type A aortic dissection were operated since January 1, 2006 to December 31, 2016 on the basis of the Almazov National Medical Research Centre, Russia and were included in the study. The patients were divided into two groups: group-1 (81 patients with valve-preserving surgery) and group-2 (72 patients with valve-replacing surgery). An assessment of the initial state of the patients, the state of the valvular apparatus and the ascending aorta, and the indicators of the pathological morphological gradation of aortic wall changes were made. The overall mortality in the intraoperative and early postoperative period was 11.1% (17 people). No valve-associated complications were found. There were no cases of necessity for redo operation with regard to the deterioration of the function of the preserved aortic valve in group-1. According to the histological examination of the aortic wall with acute dissection, there were more pronounced inflammatory changes (p <0.05), and with subacute and chronic dissection the degree of fibrosis was more pronounced, p <0.001. The overall mortality in the late postoperative period was 8.1% (11/136 patients). The cumulative survival rate in group-1 was 80.5% of patients, in group-2 — 67.5%. The survival period in group-1 was longer and amounted to 35 (18; 61) months, compared with 12 (0.72; 50) months in group-2, p <0.05.

In case of aortic dissection type A the supracoronary replacement of ascending aorta with aortic valve repair is an effective and relatively safe technique.

Keywords: aorta, aortic valve, aortic insufficiency, valve-sparing replacement.


1. CHarchyan EH.R., Belov YU.V., Stepanenko A.B., Gens A.P., Fedulova S.V., Nikonov R.YU. Klapansberegayushchie operacii pri rassloenii aorty A tipa s aortal’noj nedostatochnost’yu // Kardiologiya. 2014. № 6. s. 91–96.

2. Berretta P, Patel HJ, Gleason TG, et al. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg 2016;5:346-51. 10.21037/acs.2016.05.10

3. Conzelmann L.O., Weigang E., Mehlhorn U., Abugameh A., Hoffmann I., Blettner M., Etz C.D., Czerny M., Vahl C.F. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA) // European Journal of Cardio-thoracic Surgery. 2016. Vol. 49. No. 2. P. 44–52. DOI: 10.1093/ejcts/ezv356.

4. Erbel, R. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) / V. Aboyans, C. Boileau, E. Bossone // Eur Heart J. — 2014. — Vol. 35. — P. 2873-926.

5. Hiratzka, L.F. 2010 ACCF / AHA / AATS / ACR / ASA / SCA / SCAI / SIR / STS / SVM Guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine / G. L. Bakris, J. A. Beckman, R. M. Bersin // Circulation. — 2010. — Vol. 121. — P. 266-369.

6. Kunzelman K.S., Grande K.J., David T.E., Cochran R.P., Verrier E.D. Aortic root and valve relationships. Impact on surgical repair // The Journal of thoracic and cardiovascular surgery. 1994. Vol. 107. No. 1. p. 162–170.

7. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. JA, Elefteriades. 4, 2002 : Ann Thorac Surg., Т. 75, стр. S1877-80.

8. Stanger O., Schachner T., Gahl B., Oberwalder P., Englberger L., Thalmann M., Harrington D., Wiedemann D., Südkamp M., Sheppard M.N., Field M., Rylski B., Petrou M., Carrel T., Bonatti J., Pepper J. Type A aortic dissection after nonaortic cardiac surgery // Circulation. 2013. Vol. 128. No. 15. p. 1602–1611. DOI: 10.1161/ CIRCULATIONAHA.113.002603.

For citation

Gordeev M.L., Uspenskij V.E., Kim G.I., Kucherenko V.S., Najmushin A.V., Fokin V.A., Mitrofanova L.B., Moiseeva O.M. Early and long-term outcomes of valve-sparing replacement in aortic dissection type А. Bulletin of Pirogov National Medical & Surgical Center. 2018;13(4):23-28. (In Russ.)