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. 2017 Oct 3;6(10):e006376.
doi: 10.1161/JAHA.117.006376.

Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy

Hanghang Wang  1 , Matthew Wagner  1 , Ehsan Benrashid  1 , Jeffrey Keenan  1 , Alice Wang  1 , David Ranney  1 , Babatunde Yerokun  1 , Jeffrey G Gaca  1 , Richard L McCann  1 , G Chad Hughes  2
Affiliations

Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy

Hanghang Wang et al. J Am Heart Assoc. .

Abstract

Background: The optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy.

Methods and results: All aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes included organ-specific morbidity and 1- and 5-year outcomes as estimated using the Kaplan-Meier method. The majority of initial reoperations were proximal aortic (aortic valve, aortic root, or ascending) or aortic arch procedures (62.5%, n=55); most initial reoperations were performed in the elective setting (83.1%, n=74). Additional nonstaged second or more reoperations were required in 21 patients (23.6%) after the initial reoperation, during a median follow-up of 2.5 years after the initial reoperation. Thirty-day or in-hospital mortality for all reoperations was 7.0% (elective: 6.3%; nonelective: 11.1%) with acceptable rates of organ-specific morbidity, given the procedural complexity. One- and 5-year overall survival after initial reoperation was 85.9% and 64.9%, respectively, with aorta-specific survival of 88% at 5 years.

Conclusions: Reoperation after acute type A aortic dissection repair is associated with low rates of mortality and morbidity. These data support more limited index repair for acute type A dissection, especially for patients undergoing index repair in lower volume centers without expertise in extensive repair, because reoperations, if needed, can be performed safely in referral aortic centers.

Keywords: aortic dissection; aortic surgery.

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Figures

Figure 1
Figure 1
Kaplan–Meier estimates of overall survival (top) and aorta‐specific survival (bottom) after initial reoperation following index type A dissection repair.
Figure 2
Figure 2
Kaplan–Meier estimates of freedom from aortic intervention after initial reoperation following index type A dissection repair.
See this image and copyright information in PMC

References

    1. Rylski B, Beyersdorf F, Kari FA, Schlosser J, Blanke P, Siepe M. Acute type A aortic dissection extending beyond ascending aorta: limited or extensive distal repair. J Thorac Cardiovasc Surg. 2014;148:949–954. - PubMed
    1. Matalanis G, Perera NK, Galvin SD, Director GM. Total aortic repair: the new paradigm in the treatment of acute type A aortic dissection. Ann Cardiothorac Surg. 2016;5:216–221. - PMC - PubMed
    1. Li B, Ma W‐G, Liu Y‐M, Sun L‐Z. Is extended arch replacement justified for acute type A aortic dissection? Interact Cardiovasc Thorac Surg. 2015;20:120–126. - PubMed
    1. Shi E, Gu T, Yu Y, Yu L, Wang C, Fang Q, Zhang Y. Early and midterm outcomes of hemiarch replacement combined with stented elephant trunk in the management of acute DeBakey type I aortic dissection: comparison with total arch replacement. J Thorac Cardiovasc Surg. 2014;148:2125–2131. - PubMed
    1. Di Eusanio M, Berretta P, Cefarelli M, Jacopo A, Murana G, Castrovinci S, Di Bartolomeo R. Total arch replacement versus more conservative management in type A acute aortic dissection. Ann Thorac Surg. 2015;100:88–94. - PubMed

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