- Department of Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230032, P. R. China;
ZHANG Chengxin,
Email: zhangchengxin@ahmu.edu.cn
Acute type A aortic dissection is a lethal disease that requires immediate surgical intervention and lifesaving measures. The treatment of this condition primarily involves addressing the complex structure and vital role of the aortic root. Since 1968, surgical techniques for aortic dissection type A have rapidly advanced, significantly improving patients' outcomes. In recent years, various approaches to aortic root management have emerged. This article provides a comprehensive overview of these approaches.
Citation： WANG Xiangyu, ZHANG Chengxin. Progress in the root treatment of acute type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(8): 1189-1194. doi: 10.7507/1007-4848.202307002 Copy
Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
| 1. | Debakey ME, Henly WS, Cooley DA, et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg, 1965, 49: 130-149. |
| 2. | Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3): 237-247. |
| 3. | Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation, 2005, 112(24): 3802-3813. |
| 4. | Salica A, Pisani G, Morbiducci U, et al. The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve. Eur J Cardiothorac Surg, 2016, 49(4): 1222-1227. |
| 5. | Yacoub MH, Kilner PJ, Birks EJ, et al. The aortic outflow and root: a tale of dynamism and crosstalk. Ann Thorac Surg, 1999, 68(3 Suppl): S37-S43. |
| 6. | Coselli JS and LeMaire SA, editing. Aortic Arch Surgery: Principles, Strategies and Outcomes. Oxford: Blackwell Publishing, 2008. 13-26. |
| 7. | Wang H, Wagner M, Benrashid E, et al. Outcomes of reoperation after acute type A aortic dissection: implications for index repair strategy. J Am Heart Assoc, 2017, 6(10): e006376. |
| 8. | Isselbacher EM, Preventza O, Hamilton Black J, et al. 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. Circulation, 2022, 146(24): e334-e482. |
| 9. | Parikh N, Trimarchi S, Gleason TG, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection Interventional Cohort Program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79. |
| 10. | Kunihara T. Anatomy of the aortic root: implications for aortic root reconstruction. Gen Thorac Cardiovasc Surg, 2017, 65(9): 488-499. |
| 11. | Khelil N, Sleilaty G, Palladino M, et al. Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg, 2015, 99(4): 1220-1226. |
| 12. | Cheng A, Dagum P, Miller DC. Aortic root dynamics and surgery: from craft to science. Philos Trans R Soc Lond B Biol Sci, 2007, 362(1484): 1407-1419. |
| 13. | Kheradvar A, Vannan MA, Dasi LP, et al. The effect of aortic root anatomy and vortex flow induced shear stress on the aortic valve leaflets. Eur Heart J Cardiovasc Imaging, 2021, 22(9): 995-997. |
| 14. | Stein PD, Blick EF, Shields SK, et al. Sinus of Valsalva: a converging nozzle that contributes to stable flow in the coronary arteries. J Anat, 2014, 225(1): 94-97. |
| 15. | Kachroo P, Kelly MO, Bakir NH, et al. Impact of aortic valve effective height following valve-sparing root replacement on postoperative insufficiency and reoperation. J Thorac Cardiovasc Surg, 2022, 164(6): 1672-1680. |
| 16. | Debakey ME, Cooley DA, Creech O. Surgical considerations of dissecting aneurysm of the aorta. Ann Surg, 1955, 142(4): 586-610. |
| 17. | Kazui T, Washiyama N, Bashar AH, et al. Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. Ann Thorac Surg, 2001, 72(2): 509-514. |
| 18. | Suzuki S, Masuda M, Imoto K. The use of surgical glue in acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2014, 62(4): 207-213. |
| 19. | Fleck TM, Tschernich H, Grabenwoger M, et al. A double patch sandwich technique for surgical repair of acute aortic dissection type A. Ann Thorac Surg, 2003, 76(2): 499-502. |
| 20. | Ohata T, Miyamoto Y, Mitsuno M, et al. Modified sandwich technique for acute aortic dissection. Asian Cardiovasc Thorac Ann, 2007, 15(3): 261-263. |
| 21. | Mutsuga M, Yagami K, Fujita T, et al. "Millefeuille Technique" by using excised intimal layers in repair of type A aortic dissection. Heart Lung Circ, 2021, 30(12): 1938-1941. |
| 22. | Bavaria JE, Pochettino A, Brinster DR, et al. New paradigms and improved results for the surgical treatment of acute type A dissection. Ann Surg, 2001, 234(3): 336-342. |
| 23. | Huang LC, Xu Z, Dai XF. A new patch technique for valve-sparing aortic root repair in acute type A aortic dissection. Ann Transl Med, 2021, 9(11): 949. |
| 24. | Xue Y, Zhou Q, Pan J, et al. "Double Jacket Wrapping" root reconstruction for acute type A aortic dissection. Ann Thorac Surg, 2020, 110(3): 1060-1062. |
| 25. | Zhu C, Piao H, Wang Y, et al. A new aortic root reinforcement technique for acute type A aortic dissection surgery. Int Heart J, 2019, 60(5): 1131-1136. |
| 26. | Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: a new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750. |
| 27. | Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339. |
| 28. | Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg, 1993, 105(3): 435-438. |
| 29. | David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg, 1992, 103(4): 617-622. |
| 30. | Mookhoek A, Korteland NM, Arabkhani B, et al. Bentall procedure: a systematic review and meta-analysis. Ann Thorac Surg, 2016, 101(5): 1684-1689. |
| 31. | Svensson LG, Rosinski BF, Tucker NJ, et al. Comparison of outcomes of patients undergoing reimplantation versus Bentall root procedure. Aorta (Stamford), 2022, 10(2): 57-68. |
| 32. | Bethancourt CN, Blitzer D, Yamabe T, et al. Valve-sparing root replacement versus Bio-Bentall: inverse propensity weighting of 796 patients. Ann Thorac Surg, 2022, 113(5): 1529-1535. |
| 33. | Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med, 2017, 377(19): 1847-1857. |
| 34. | Gaudino M, Di Franco A, Ohmes LB, et al. Biological solutions to aortic root replacement: valve-sparing versus bioprosthetic conduit. Interact Cardiovasc Thorac Surg, 2017, 24(6): 855-861. |
| 35. | Yan TD. Mini-Bentall procedure. Ann Cardiothorac Surg, 2015, 4(2): 182-190. |
| 36. | Felipe Gaia D, Bernal O, Castilho E, et al. First-in-human Endo-Bentall procedure for simultaneous treatment of the ascending aorta and aortic valve. JACC Case Rep, 2020, 2(3): 480-485. |
| 37. | Fagan A, Yacoub MH, Pillai R, et al. Dacron replacement of the ascending aorta and sinuses with resuspension of the aortic valve and re-implantation of the coronary arteries: a new method for treatment of aneurysmal or acute dissection of the aortic root. Scand J Cardiothorac Surg, 1982, 16: 6. |
| 38. | Yacoub MH, Aguib H, Gamrah MA, et al. Aortic root dynamism, geometry, and function after the remodeling operation: clinical relevance. J Thorac Cardiovasc Surg, 2018, 156(3): 951-962. |
| 39. | Leyh RG, Fischer S, Kallenbach K, et al. High failure rate after valve-sparing aortic root replacement using the "remodeling technique" in acute type A aortic dissection. Circulation, 2002, 106(12 Suppl 1): I229-I233. |
| 40. | Giebels C, Fister JC, Ehrlich T, et al. Failures of valve-sparing aortic root replacement using the root remodeling technique. Ann Thorac Surg, 2022, 113(6): 2000-2006. |
| 41. | Kunihara T, Neumann N, Kriechbaum SD, et al. Aortic root remodeling leads to good valve stability in acute aortic dissection and preexistent root dilatation. J Thorac Cardiovasc Surg, 2016, 152(2): 430-436. |
| 42. | Froede L, Abeln KB, Ehrlich T, et al. Twenty-five years' experience with root remodeling and bicuspid aortic valve repair. Ann Cardiothorac Surg, 2022, 11(4): 418-425. |
| 43. | Ehrlich T, Abeln KB, Burgard C, et al. Twenty-five years of root remodelling for root aneurysm and tricuspid aortic valve. Eur J Cardiothorac Surg, 2023, 63(6): ezad137. |
| 44. | Abeln KB, Ehrlich T, Froede L, et al. Remodeling of the aortic root: a 28-year journey. Ann Cardiothorac Surg, 2023, 12(3): 225-236. |
| 45. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 46. | Ehrlich T, Karliova I, Froede L, et al. Aortic root remodeling in acute aortic dissection. Thorac Cardiovasc Surg, 2021, 69(4): 329-335. |
| 47. | Rylski B, Hoffmann I, Beyersdorf F, et al. Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg, 2014, 259(3): 598-604. |
| 48. | Czerny M, Siepe M, Beyersdorf F, et al. Prediction of mortality rate in acute type A dissection: the German Registry for Acute Type A Aortic Dissection score. Eur J Cardiothorac Surg, 2020, 58(4): 700-706. |
| 49. | Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042. |
| 50. | Schäfers HJ, Raddatz A, Schmied W, et al. Reexamining remodeling. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S30-S36. |
| 51. | Kunihara T, Arimura S, Sata F, et al. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg, 2018, 155(3): 885-894. |
| 52. | Manganiello S, Soquet J, Mugnier A, et al. David procedure: a 21-year experience with 300 patients. Ann Thorac Surg, 2023, 115(6): 1403-1410. |
| 53. | Beckmann E, Martens A, Krüger H, et al. Aortic valve-sparing root replacement with Tirone E. David's reimplantation technique: single-centre 25-year experience. Eur J Cardiothorac Surg, 2021, 60(3): 642-648. |
| 54. | David TE, David CM, Ouzounian M, et al. A progress report on reimplantation of the aortic valve. J Thorac Cardiovasc Surg, 2021, 161(3): 890-899. |
| 55. | David TE, David CM, Feindel CM, et al. Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg, 2017, 153(2): 232-238. |
| 56. | le Polain de Waroux JB, Pouleur AC, Robert A, et al. Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging, 2009, 2(8): 931-939. |
| 57. | Patlolla SH, Saran N, Dearani JA, et al. Outcomes and risk factors of late failure of valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2022, 164(2): 493-501. |
| 58. | Demers P, Miller DC. Simple modification of "T. David-V" valve-sparing aortic root replacement to create graft pseudosinuses. Ann Thorac Surg, 2004, 78(4): 1479-1481. |
| 59. | De Paulis R, Scaffa R, Weltert L, et al. Mimicking mother nature: the Valsalva graft. J Thorac Cardiovasc Surg, 2020, 159(5): 1758-1763. |
| 60. | Giebels C, Aicher D, Kunihara T, et al. Causes and management of aortic valve regurgitation after aortic valve reimplantation. J Thorac Cardiovasc Surg, 2013, 145(3): 774-780. |
| 61. | Price J, Magruder JT, Young A, et al. Long-term outcomes of aortic root operations for Marfan syndrome: a comparison of Bentall versus aortic valve-sparing procedures. J Thorac Cardiovasc Surg, 2016, 151(2): 330-336. |
| 62. | Leontyev S, Schamberger L, Davierwala PM, et al. Early and late results after David vs. Bentall procedure: a propensity matched analysis. Ann Thorac Surg, 2020, 110(1): 120-126. |
| 63. | Hess PJ, Harman PK, Klodell CT, et al. Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms. Ann Thorac Surg, 2009, 87(4): 1161-1168. |
| 64. | Heo W, Min HK, Kang DK, et al. A modified root reinforcement technique for acute aortic dissection with a weakened aortic root: a modified Florida sleeve technique and two cases report. J Cardiothorac Surg, 2013, 8: 203. |
| 65. | Alhussaini M, Jeng EI, Martin TD, et al. Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection. J Card Surg, 2022, 37(1): 39-46. |
| 66. | Aalaei-Andabili SH, Beaver TM, Martin TD, et al. Outcomes of Florida sleeve procedure in patients with bicuspid versus tricuspid aortic valve. Innovations (Phila), 2020, 15(4): 361-368. |
| 67. | Holubec T, Rashid H, Hecker F, et al. Early- and longer-term outcomes of David versus Florida sleeve procedure: propensity-matched comparison. Eur J Cardiothorac Surg, 2022, 62(3): ezac104. |
| 68. | Pepper J, Petrou M, Rega F, et al. Implantation of an individually computer-designed and manufactured external support for the Marfan aortic root. Multimed Man Cardiothorac Surg, 2013, 2013: mmt004. |
- 1. Debakey ME, Henly WS, Cooley DA, et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg, 1965, 49: 130-149.
- 2. Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3): 237-247.
- 3. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation, 2005, 112(24): 3802-3813.
- 4. Salica A, Pisani G, Morbiducci U, et al. The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve. Eur J Cardiothorac Surg, 2016, 49(4): 1222-1227.
- 5. Yacoub MH, Kilner PJ, Birks EJ, et al. The aortic outflow and root: a tale of dynamism and crosstalk. Ann Thorac Surg, 1999, 68(3 Suppl): S37-S43.
- 6. Coselli JS and LeMaire SA, editing. Aortic Arch Surgery: Principles, Strategies and Outcomes. Oxford: Blackwell Publishing, 2008. 13-26.
- 7. Wang H, Wagner M, Benrashid E, et al. Outcomes of reoperation after acute type A aortic dissection: implications for index repair strategy. J Am Heart Assoc, 2017, 6(10): e006376.
- 8. Isselbacher EM, Preventza O, Hamilton Black J, et al. 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. Circulation, 2022, 146(24): e334-e482.
- 9. Parikh N, Trimarchi S, Gleason TG, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection Interventional Cohort Program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79.
- 10. Kunihara T. Anatomy of the aortic root: implications for aortic root reconstruction. Gen Thorac Cardiovasc Surg, 2017, 65(9): 488-499.
- 11. Khelil N, Sleilaty G, Palladino M, et al. Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg, 2015, 99(4): 1220-1226.
- 12. Cheng A, Dagum P, Miller DC. Aortic root dynamics and surgery: from craft to science. Philos Trans R Soc Lond B Biol Sci, 2007, 362(1484): 1407-1419.
- 13. Kheradvar A, Vannan MA, Dasi LP, et al. The effect of aortic root anatomy and vortex flow induced shear stress on the aortic valve leaflets. Eur Heart J Cardiovasc Imaging, 2021, 22(9): 995-997.
- 14. Stein PD, Blick EF, Shields SK, et al. Sinus of Valsalva: a converging nozzle that contributes to stable flow in the coronary arteries. J Anat, 2014, 225(1): 94-97.
- 15. Kachroo P, Kelly MO, Bakir NH, et al. Impact of aortic valve effective height following valve-sparing root replacement on postoperative insufficiency and reoperation. J Thorac Cardiovasc Surg, 2022, 164(6): 1672-1680.
- 16. Debakey ME, Cooley DA, Creech O. Surgical considerations of dissecting aneurysm of the aorta. Ann Surg, 1955, 142(4): 586-610.
- 17. Kazui T, Washiyama N, Bashar AH, et al. Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. Ann Thorac Surg, 2001, 72(2): 509-514.
- 18. Suzuki S, Masuda M, Imoto K. The use of surgical glue in acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2014, 62(4): 207-213.
- 19. Fleck TM, Tschernich H, Grabenwoger M, et al. A double patch sandwich technique for surgical repair of acute aortic dissection type A. Ann Thorac Surg, 2003, 76(2): 499-502.
- 20. Ohata T, Miyamoto Y, Mitsuno M, et al. Modified sandwich technique for acute aortic dissection. Asian Cardiovasc Thorac Ann, 2007, 15(3): 261-263.
- 21. Mutsuga M, Yagami K, Fujita T, et al. "Millefeuille Technique" by using excised intimal layers in repair of type A aortic dissection. Heart Lung Circ, 2021, 30(12): 1938-1941.
- 22. Bavaria JE, Pochettino A, Brinster DR, et al. New paradigms and improved results for the surgical treatment of acute type A dissection. Ann Surg, 2001, 234(3): 336-342.
- 23. Huang LC, Xu Z, Dai XF. A new patch technique for valve-sparing aortic root repair in acute type A aortic dissection. Ann Transl Med, 2021, 9(11): 949.
- 24. Xue Y, Zhou Q, Pan J, et al. "Double Jacket Wrapping" root reconstruction for acute type A aortic dissection. Ann Thorac Surg, 2020, 110(3): 1060-1062.
- 25. Zhu C, Piao H, Wang Y, et al. A new aortic root reinforcement technique for acute type A aortic dissection surgery. Int Heart J, 2019, 60(5): 1131-1136.
- 26. Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: a new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750.
- 27. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
- 28. Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg, 1993, 105(3): 435-438.
- 29. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg, 1992, 103(4): 617-622.
- 30. Mookhoek A, Korteland NM, Arabkhani B, et al. Bentall procedure: a systematic review and meta-analysis. Ann Thorac Surg, 2016, 101(5): 1684-1689.
- 31. Svensson LG, Rosinski BF, Tucker NJ, et al. Comparison of outcomes of patients undergoing reimplantation versus Bentall root procedure. Aorta (Stamford), 2022, 10(2): 57-68.
- 32. Bethancourt CN, Blitzer D, Yamabe T, et al. Valve-sparing root replacement versus Bio-Bentall: inverse propensity weighting of 796 patients. Ann Thorac Surg, 2022, 113(5): 1529-1535.
- 33. Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med, 2017, 377(19): 1847-1857.
- 34. Gaudino M, Di Franco A, Ohmes LB, et al. Biological solutions to aortic root replacement: valve-sparing versus bioprosthetic conduit. Interact Cardiovasc Thorac Surg, 2017, 24(6): 855-861.
- 35. Yan TD. Mini-Bentall procedure. Ann Cardiothorac Surg, 2015, 4(2): 182-190.
- 36. Felipe Gaia D, Bernal O, Castilho E, et al. First-in-human Endo-Bentall procedure for simultaneous treatment of the ascending aorta and aortic valve. JACC Case Rep, 2020, 2(3): 480-485.
- 37. Fagan A, Yacoub MH, Pillai R, et al. Dacron replacement of the ascending aorta and sinuses with resuspension of the aortic valve and re-implantation of the coronary arteries: a new method for treatment of aneurysmal or acute dissection of the aortic root. Scand J Cardiothorac Surg, 1982, 16: 6.
- 38. Yacoub MH, Aguib H, Gamrah MA, et al. Aortic root dynamism, geometry, and function after the remodeling operation: clinical relevance. J Thorac Cardiovasc Surg, 2018, 156(3): 951-962.
- 39. Leyh RG, Fischer S, Kallenbach K, et al. High failure rate after valve-sparing aortic root replacement using the "remodeling technique" in acute type A aortic dissection. Circulation, 2002, 106(12 Suppl 1): I229-I233.
- 40. Giebels C, Fister JC, Ehrlich T, et al. Failures of valve-sparing aortic root replacement using the root remodeling technique. Ann Thorac Surg, 2022, 113(6): 2000-2006.
- 41. Kunihara T, Neumann N, Kriechbaum SD, et al. Aortic root remodeling leads to good valve stability in acute aortic dissection and preexistent root dilatation. J Thorac Cardiovasc Surg, 2016, 152(2): 430-436.
- 42. Froede L, Abeln KB, Ehrlich T, et al. Twenty-five years' experience with root remodeling and bicuspid aortic valve repair. Ann Cardiothorac Surg, 2022, 11(4): 418-425.
- 43. Ehrlich T, Abeln KB, Burgard C, et al. Twenty-five years of root remodelling for root aneurysm and tricuspid aortic valve. Eur J Cardiothorac Surg, 2023, 63(6): ezad137.
- 44. Abeln KB, Ehrlich T, Froede L, et al. Remodeling of the aortic root: a 28-year journey. Ann Cardiothorac Surg, 2023, 12(3): 225-236.
- 45. Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831.
- 46. Ehrlich T, Karliova I, Froede L, et al. Aortic root remodeling in acute aortic dissection. Thorac Cardiovasc Surg, 2021, 69(4): 329-335.
- 47. Rylski B, Hoffmann I, Beyersdorf F, et al. Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg, 2014, 259(3): 598-604.
- 48. Czerny M, Siepe M, Beyersdorf F, et al. Prediction of mortality rate in acute type A dissection: the German Registry for Acute Type A Aortic Dissection score. Eur J Cardiothorac Surg, 2020, 58(4): 700-706.
- 49. Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042.
- 50. Schäfers HJ, Raddatz A, Schmied W, et al. Reexamining remodeling. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S30-S36.
- 51. Kunihara T, Arimura S, Sata F, et al. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg, 2018, 155(3): 885-894.
- 52. Manganiello S, Soquet J, Mugnier A, et al. David procedure: a 21-year experience with 300 patients. Ann Thorac Surg, 2023, 115(6): 1403-1410.
- 53. Beckmann E, Martens A, Krüger H, et al. Aortic valve-sparing root replacement with Tirone E. David's reimplantation technique: single-centre 25-year experience. Eur J Cardiothorac Surg, 2021, 60(3): 642-648.
- 54. David TE, David CM, Ouzounian M, et al. A progress report on reimplantation of the aortic valve. J Thorac Cardiovasc Surg, 2021, 161(3): 890-899.
- 55. David TE, David CM, Feindel CM, et al. Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg, 2017, 153(2): 232-238.
- 56. le Polain de Waroux JB, Pouleur AC, Robert A, et al. Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging, 2009, 2(8): 931-939.
- 57. Patlolla SH, Saran N, Dearani JA, et al. Outcomes and risk factors of late failure of valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2022, 164(2): 493-501.
- 58. Demers P, Miller DC. Simple modification of "T. David-V" valve-sparing aortic root replacement to create graft pseudosinuses. Ann Thorac Surg, 2004, 78(4): 1479-1481.
- 59. De Paulis R, Scaffa R, Weltert L, et al. Mimicking mother nature: the Valsalva graft. J Thorac Cardiovasc Surg, 2020, 159(5): 1758-1763.
- 60. Giebels C, Aicher D, Kunihara T, et al. Causes and management of aortic valve regurgitation after aortic valve reimplantation. J Thorac Cardiovasc Surg, 2013, 145(3): 774-780.
- 61. Price J, Magruder JT, Young A, et al. Long-term outcomes of aortic root operations for Marfan syndrome: a comparison of Bentall versus aortic valve-sparing procedures. J Thorac Cardiovasc Surg, 2016, 151(2): 330-336.
- 62. Leontyev S, Schamberger L, Davierwala PM, et al. Early and late results after David vs. Bentall procedure: a propensity matched analysis. Ann Thorac Surg, 2020, 110(1): 120-126.
- 63. Hess PJ, Harman PK, Klodell CT, et al. Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms. Ann Thorac Surg, 2009, 87(4): 1161-1168.
- 64. Heo W, Min HK, Kang DK, et al. A modified root reinforcement technique for acute aortic dissection with a weakened aortic root: a modified Florida sleeve technique and two cases report. J Cardiothorac Surg, 2013, 8: 203.
- 65. Alhussaini M, Jeng EI, Martin TD, et al. Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection. J Card Surg, 2022, 37(1): 39-46.
- 66. Aalaei-Andabili SH, Beaver TM, Martin TD, et al. Outcomes of Florida sleeve procedure in patients with bicuspid versus tricuspid aortic valve. Innovations (Phila), 2020, 15(4): 361-368.
- 67. Holubec T, Rashid H, Hecker F, et al. Early- and longer-term outcomes of David versus Florida sleeve procedure: propensity-matched comparison. Eur J Cardiothorac Surg, 2022, 62(3): ezac104.
- 68. Pepper J, Petrou M, Rega F, et al. Implantation of an individually computer-designed and manufactured external support for the Marfan aortic root. Multimed Man Cardiothorac Surg, 2013, 2013: mmt004.