Study Design
All patients admitted to the Royal Brompton and Harefield NHS Foundation Trust between January 2009 and December 2018 with ATAAD and who underwent emergency surgery were identified for inclusion in this study. Perioperative data was prospectively collated with adherence to national guidelines for cardiothoracic surgery data reporting including data collection on baseline demographics, operative variables and short-term outcomes [7]. Long term mortality was assessed using the NHS Spine database [8]. The requirement for ethical approval was waived by the Research Ethics Office at Royal Brompton and Harefield NHS Foundation Trust due to the retrospective nature of the study.
Patients included in this study were divided into two cohorts determined by whether the native aortic root (including valve) was replaced or preserved at the time of emergency surgery. In the first cohort, patients undergoing aortic root replacement (ARR) had either a composite valve-graft replacement (Bentall’s procedure) or porcine valve-graft replacement (Freestyle procedure). In the second cohort, patients underwent an asacending aorta interposition graft (AAG) with preservation of the aortic root and resuspension of the native aortic valve. No patients in this institution underwent valve-sparing root replacement (e.g. David/Yacoub procedures) for ATAAD. To ensure homogeneity of the cohort, all patients undergoing replacement of the arch (e.g. total arch replacement, frozen elephant trunk) were excluded from the study.