Fate of the aortic root after reconstruction with felt Neomedia for acute type A aortic dissection

Abstract OBJECTIVES We sought to characterize the durability of aortic root reconstruction with felt neomedia for acute type A aortic dissection. METHODS Of 894 patients undergoing type A aortic dissection repair between 2010 and 2024 at a single institution, 537 underwent aortic root reconstruction with felt neomedia and aortic valve resuspension (median age 64 years, 37.2% female). Median follow-up was 4.3 years. Outcomes included survival, proximal aortic reintervention, greater than moderate aortic insufficiency, and root dilatation. Predictors of a composite outcome—defined as proximal aortic reintervention, greater than moderate aortic insufficiency, or root dilatation ≥ 50 mm—were evaluated. RESULTS Preoperatively, 19.9% of patients had greater than moderate aortic insufficiency and median root diameter was 39.0 mm. 30-day mortality was 12.8% and 10-year survival was 52.3%. The cumulative incidence of proximal aortic reintervention at 1, 5, and 10 years was 0.4%, 2.4%, and 5.5%. During follow-up, 13 patients developed greater than moderate aortic insufficiency and 16 developed root dilatation ≥ 50 mm. Freedom from the composite outcome was 98.8% at 1 year and 91.9% at 5 years. On multivariable analysis, preoperative aortic insufficiency and baseline root diameter ≥ 45 mm were independent predictors of the composite outcome. CONCLUSIONS Aortic root reconstruction with felt neomedia and aortic valve resuspension is a durable technique for acute type A aortic dissection. Patients with preoperative aortic insufficiency or root dilatation are at increased risk for root-related events and warrant close surveillance.