Is Adjunct Aortic Valve Surgery a Mortality Risk Factor in Patients Receiving Ascending Aortic and Aortic Arch Surgery for Dissection or Aneurysm?

All articles of this category (opens in new window) Background: The aim of this study is to evaluate and identify risk factors for in-hospital mortality of ascending aortic and aortic arch replacement for aortic dissection or aneurysm with and without aortic valve surgery. Methods: From 2020 to 2024, first-time ascending aortic and aortic arch replacement was performed under hypothermic circulatory arrest and selective bilateral cerebral perfusion at one institution: 107 patients (70% males, 66.50 ± 11.24 years) underwent surgery for ascending aneurysm (AAA), and 65 (71% males, 59.75 ± 11.78 years) for acute dissection (AAD). Pre-, intra-, and postoperative data were retrospectively collected and statistically evaluated. Results: Aortic valve/root surgery was performed in 18.75% AAD and 31.78% AAA patients ( p < 0.01). Operation time (396.1 ± 131.5 vs. 386.1 ± 136.5 minutes, p = 0.319) and HLM-time (232.3 ±80.2 vs. 215.4 ± 87.8 minutes, p = 0.119) were similar in AAD and AAA, respectively. AAD surgery required longer circulatory arrest (54.5 ± 28.6 vs. 41.2 ± 31.4 minutes, p = 0.0032), more intraoperative (3.5 ± 4.3 vs. 2.0 ± 3.3, p < 0.01) and total PRBC transfusion (7.4 ± 10.1 vs. 4.7 ± 6.3, p < 0.05) than AAA. In-hospital mortality was 21.9% (AAD) and 5.6% (AAA), p = 0.0026. Aortic valve/root surgery didn't increase mortality (AAD, p = 0.634; AAA, p = 0.967). Operation time (ccoeff = 0.489, p < 0.0001; ccoeff = 0.251, p = 0.043) and HLM-Time (ccoeff = 0.45, p < 0.0001; ccoeff = 0.385, p = 0.0014) correlated with mortality in AAA and DAA, respectively. Circulatory arrest time and the magnitude of arch surgery correlated with mortality in the AAA (ccoef = 0.427, p < 0.0001; ccoef = 0.240, p = 0.012) but not in the AAD patients (ccoeff = 0.239, p = 0.055; ccoeff = 0.157, p = 0.211), respectively. Intraoperative (ccoef = 0.509; ccoef = 0.475) and total PRBC transfusion (ccoef = 0.625; ccoef = 0.493) showed the strongest correlation with mortality in AAA and DAA patients, respectively ( p < 0.0001). Conclusion: Aortic valve and root surgery performed in addition to ascending/arch aortic surgery does not increase mortality independently of the aortic pathology. Whereas the magnitude of the aortic arch repair impacts mortality in aneurysmal disease, it seems not to increase the risk for death when performed for dissection. The quality and radicality of the surgical repair, combined with reduced need for red-cell transfusion, are the most important factors in reducing early mortality in patients with Type A aortic dissection. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany