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. 2024 Mar 1:11:1340687.
doi: 10.3389/fcvm.2024.1340687. eCollection 2024.

Clinical study of reoperation for acute type A aortic dissection

Yi Feng  1 , Xian-Tao Ma  1 , Xiao-Xue Zhang  1 , Akilu Wajeehullahi  1 , Zi-Jun Chen  2 , Shi-Liang Li  1 , Cai Cheng  1
Affiliations

Clinical study of reoperation for acute type A aortic dissection

Yi Feng et al. Front Cardiovasc Med. .

Abstract

Objective: The initial operation for type A aortic dissection has limitations, and there may be a need for reoperation in cases such as giant pseudoaneurysm formation and reduced blood supply to the distal vessels. In this study, we collected case data of patients who underwent cardiac major vascular surgery at our hospital to analyze the effectiveness of reoperation treatment options for type A aortic dissection and to summarize our treatment experience.

Method: Between June 2018 and December 2022, 62 patients with type A aortic dissection (TAAD) underwent reoperation after previous surgical treatment. Of these, 49 patients (45 males) underwent endovascular aortic repair (EVAR) with a mean age of (49.69 ± 10.21) years (30-75 years), and 13 patients (11 males) underwent thoracoabdominal aortic replacement (TAAR) with a mean age of (41.00 ± 11.18) years (23-66 years). In this study, we retrospectively analyzed the recorded data of 62 patients. In addition, we summarized and analyzed their Computed Tomographic Angiography (CTA) results and perioperative complications.

Outcome: In the EVAR group, 47 patients (95.92%) were successfully implanted with overlapping stents, and 2 patients died in the perioperative period. Postoperative complications included cerebral infarction (4.08%), acute renal insufficiency (30.61%), pulmonary insufficiency and need for ventilator (6.12%), poor wound healing (2.04%), postoperative reoperation (16.33%), and lower limb ischemia (2.04%). In the TAAR group, 12 patients (92.31%) were successfully revascularized and 1 patient died in the perioperative period. Postoperative complications included cerebral infarction (7.69%), acute kidney injury (46.15%), pulmonary insufficiency and need for ventilator (15.38%), poor wound healing (30.77%) and postoperative reoperation (15.38%).

Conclusion: According to the results of the study, compared with TAAR, EVAR was less invasive, faster recovery, and offered a better choice for some high-risk and high-age patients with comorbid underlying diseases. However, the rate of revascularization was higher after EVAR than TAAR due to vascular lesions. Compared with the use of ascending aortic replacement + hemi-aortic arch replacement for acute type A aortic dissection in many countries and regions, the use of ascending aortic replacement + aortic arch replacement + elephant trunk stent is more traumatic in China, but facilitates reoperation. For young patients, the choice of treatment should be individualized combining vascular lesions and long-term quality of life.

Keywords: clinical effect; endovascular aortic repair; reoperation; thoracoabdominal aortic replacement; type A aortic dissection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The process of TAAR. (A) A joint left thoracoabdominal incision; (B) anastomosis of a four-branch artificial vessel to a Y-shaped artificial vessel; (C) after iliac artery revascularization, the aneurysm body is incised to look for visceral vascular openings; (D) thoracoabdominal aortic revascularization complete.
Figure 2
Figure 2
Zoning of CTA. The s1 plane and s2 plane in the longitudinal section.
Figure 3
Figure 3
Comparison of EVAR before and after surgery by CTA. The second surgery underwent EVAR (a anteriorly and b posteriorly) with good results and significant improvement in true vena cava flow, but with residual abdominal aortic dissection, possibly facing reoperation.
Figure 4
Figure 4
Lumen diameter as assessed by CTA (n = 22 out of 49 EVAR patients).
See this image and copyright information in PMC

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