{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:43:10Z","timestamp":1760060590041,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The management of the aortic root in type A aortic dissection (TAAD) is challenging. Conservative aortic root repair is considered a reasonable option in most cases. This study aimed to analyze medium-term mortality and aortic root reintervention after TAAD. Methods: All patients with TAAD underwent prospective follow-ups between 2017 and 2021. The primary endpoint was the increase in aortic root diameter and the rate of proximal root reintervention. The secondary endpoints were the risk factor and location for root-RAD, and risk factors for severe and moderate AR and mortality during follow-up. Results: A total of 210 patients were included, of which 166 (79.0%) did not have root-RAD and 44 (21.0%) had root-RAD after supracoronary aortic replacement. After a mean follow-up of 41.1 months (0\u201360), four patients (1.8%) died. No cases of aortic root rupture were reported. Two patients in the root-RAD group underwent aortic root reoperation. The aortic root diameter increased by 0.5 mm\/year and 0.09 mm\/year in the root-RAD and no-root-RAD groups, respectively (p = 0.18). Root-RAD was a risk factor for severe AR (HR 19.6; 95%CI: 1.6\u20132.7; p = 0.05) and an independent risk factor for moderate AR (HR 23.0; 95%CI: 2.8\u20132.9; p = 0.009). Conclusions: Without increasing long-term mortality, root-RAD increases the risks of AR and subsequent aortic root reintervention. Long-term follow-up is essential for monitoring aortic valve function.<\/jats:p>","DOI":"10.3390\/jcm14176274","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T09:51:21Z","timestamp":1757065881000},"page":"6274","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evolution of Aortic Root Preservation After Type A Acute Aortic Dissection Repair: Impact of Root-Residual Aortic Dissection"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6822-4734","authenticated-orcid":false,"given":"Alizee","family":"Porto","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Court","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre Antoine","family":"Barral","sequence":"additional","affiliation":[{"name":"Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Boucekine","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health Cost, Assistance Publique-H\u00f4pitaux, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Imbert","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health Cost, Assistance Publique-H\u00f4pitaux, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vlad","family":"Gariboldi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Jacquier","sequence":"additional","affiliation":[{"name":"Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4247-7184","authenticated-orcid":false,"given":"Frederic","family":"Collart","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9453-9039","authenticated-orcid":false,"given":"Alexis","family":"Theron","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marine","family":"Gaudry","sequence":"additional","affiliation":[{"name":"Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.jvs.2021.08.080","article-title":"A systematic review and meta-analysis of the incidence of acute aortic dissections in population-based studies","volume":"75","author":"Gouveia","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"346","DOI":"10.21037\/acs.2016.05.10","article-title":"IRAD experience on surgical type A acute dissection patients: Results and predictors of mortality","volume":"5","author":"Berretta","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights from the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.jacc.2015.05.029","article-title":"Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection","volume":"66","author":"Pape","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jtcvs.2004.09.005","article-title":"Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience","volume":"129","author":"Trimarchi","year":"2005","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1016\/j.athoracsur.2014.06.070","article-title":"Root Replacement Surgery Versus More Conservative Management During Type A Acute Aortic Dissection Repair","volume":"98","author":"Trimarchi","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1016\/j.jtcvs.2013.12.059","article-title":"Long-term outcomes of survival and freedom from reoperation on the aortic root or valve after surgery for acute ascending aorta dissection","volume":"148","author":"Wang","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ejcts\/ezw038","article-title":"Surgical management of aortic root in type A acute aortic dissection: A propensity-score analysis","volume":"50","author":"Castrovinci","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2076","DOI":"10.1016\/j.jtcvs.2018.05.096","article-title":"Survival and reoperation after valve-sparing root replacement and root repair in acute type A dissection","volume":"156","author":"Sievers","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/icvts\/ivab324","article-title":"Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection","volume":"34","author":"Jormalainen","year":"2022","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/S0003-4975(00)02610-2","article-title":"Does the extent of proximal or distal resection influence outcome for type A dissections?","volume":"71","author":"Moon","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1016\/S0022-5223(03)01279-0","article-title":"Acute type a aortic dissection complicated by aortic regurgitation: Composite valve graft versus separate valve graft versus conservative valve repair","volume":"126","author":"Lai","year":"2003","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jama.283.7.897","article-title":"The International Registry of Acute Aortic Dissection (IRAD): New Insights into an Old Disease","volume":"283","author":"Hagan","year":"2000","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.jtcvs.2019.09.183","article-title":"The fate of aortic root and aortic regurgitation after supracoronary ascending aortic replacement for acute type A aortic dissection","volume":"161","author":"Ikeno","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/icvts\/ivz080","article-title":"Reported outcomes after aortic valve resuspension for acute type A aortic dissection: A systematic review and meta-analysis","volume":"29","author":"Chen","year":"2019","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/S0022-5223(00)70090-0","article-title":"Long-term effectiveness of operations for ascending aortic dissections","volume":"119","author":"Sabik","year":"2000","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jtcvs.2017.08.137","article-title":"Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation","volume":"155","author":"Chiu","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"II243-9","DOI":"10.1161\/01.CIR.0000138948.14144.d6","article-title":"Evolving Strategies for Treatment of Acute Aortic Dissection Type A","volume":"110","author":"Kallenbach","year":"2004","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC Guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.jtcvs.2012.07.013","article-title":"Supracoronary ascending aortic replacement in patients with acute aortic dissection type A: What happens to the aortic root in the long run?","volume":"146","author":"Rylski","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1503\/cjs.009116","article-title":"Comparison of outcomes of root replacement procedures and supracoronary techniques for surgical repair of acute aortic dissection","volume":"60","author":"Valdis","year":"2017","journal-title":"Can. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1093\/ejcts\/ezx170","article-title":"Valve-sparing David I procedure in acute aortic type A dissection: A 20-year experience with more than 100 patients","volume":"52","author":"Beckmann","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1093\/ejcts\/ezaa456","article-title":"Type A acute aortic dissection with \u226540-mm aortic root: Results of conservative and replacement strategies at long-term follow-up","volume":"59","author":"Vendramin","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jtcvs.2018.03.144","article-title":"Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry","volume":"156","author":"Pan","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/S0003-4975(01)03449-X","article-title":"Acute type A dissection: Conservative methods provide consistently low mortality","volume":"73","author":"Westaby","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1016\/j.jtcvs.2012.09.049","article-title":"Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up","volume":"146","author":"Gallo","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Magouliotis, D.E., Sicouri, S., Baudo, M., Cabrucci, F., Yamashita, Y., and Ramlawi, B. (Hellenic J. Cardiol., 2025). Comparative outcomes of aortic root preservation versus root replacement for acute type A aortic dissection: Balancing survival, durability, and reoperation, Hellenic J. Cardiol., epub ahead of print.","DOI":"10.1016\/j.hjc.2025.05.008"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1016\/j.jtcvs.2018.09.129","article-title":"Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience","volume":"157","author":"Yang","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.athoracsur.2015.10.007","article-title":"Surgical Strategy and Outcome for Aortic Root in Patients Undergoing Repair of Acute Type A Aortic Dissection","volume":"101","author":"Nishida","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/S0735-1097(00)00766-X","article-title":"Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: Implications for aortic valve repair","volume":"36","author":"Movsowitz","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1053\/j.jvca.2017.06.014","article-title":"Aortic Regurgitation in Acute Type-A Aortic Dissection: A Clinical Classification for the Perioperative Echocardiographer in the Era of the Functional Aortic Annulus","volume":"32","author":"Patel","year":"2018","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1016\/S0003-4975(99)00417-8","article-title":"Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation","volume":"67","author":"Pessotto","year":"1999","journal-title":"Ann. Thorac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1067\/mtc.2002.119702","article-title":"Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection","volume":"123","author":"Kirsch","year":"2002","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.athoracsur.2019.10.014","article-title":"Surgical Management and Outcomes of the Aortic Root in Acute Type A Aortic Dissection","volume":"110","author":"Qiu","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.jtcvs.2020.04.064","article-title":"Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection","volume":"163","author":"Bojko","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1093\/ejcts\/ezab317","article-title":"Results of a prospective follow-up study after type A aortic dissection repair: A high rate of distal aneurysmal evolution and reinterventions","volume":"61","author":"Gaudry","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6274\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:40:02Z","timestamp":1760035202000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":38,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14176274"],"URL":"https:\/\/doi.org\/10.3390\/jcm14176274","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,9,5]]}}}