Stanford A型急性大動脈解離に対する二期的大動脈基部置換術

The Strategy for Aortic Root Pathology Due to Stanford Type A Acute Aortic Dissection

Stanford A型急性大動脈解離（AAAD）の緊急大動脈基部置換術の手術成績は，海外でも本邦でも30日死亡率20％といまだ不良である．また，若年者のAAADの大動脈基部置換術では自己弁を温存したいが，術前状態のわるい緊急手術でその選択はむずかしい．

The surgical outcomes of aortic root replacement for Stanford type A acute aortic dissection （AAAD） remain unacceptable with a 30-day mortality rate of 20％. Additionally, in young patients requiring aortic root replacement for AAAD, the preservation of native valve is desirable, yet challenging to achieve in emergent surgery with poor preoperative status. Ideally, we aim to avoid aortic root replacement whenever possible, opting instead for partial remodeling even in cases necessitating incision into the aortic root. We present our surgical outcomes in the strategy for aortic root pathology due to AAAD.

We conducted an analysis of 517 cases of AAAD surgery from 2002 to 2023, wherein 499 cases （96％） underwent aortic root preservation, 10 cases （1.9％） underwent partial remodeling, and 8 cases （1.5％） necessitated emergent aortic root replacement. Of these, 13 cases underwent aortic root replacement after AAAD repair （8 David procedures and 5 Bentall procedures）, all demonstrating favorable surgical outcomes, including long-term results. We believe that this strategy for aortic root pathology holds significant merit, particularly in AAAD in young patients with enlarged aortic root.