Outcomes of Redo Total Arch Replacement After Limited Arch Repair for Acute Type A Aortic Dissection

Abstract

Background: Despite the life-saving nature of emergency surgery for acute type A aortic dissection (ATAD), debate persists on whether limited or extended arch repair is preferable. This study evaluates outcomes of redo total arch replacement after initial, limited arch repair for ATAD.

Methods: We retrospectively reviewed all patients who underwent ascending and arch repair from September 1999 to December 2024. Patients who underwent zone 2 or 3 arch replacement after limited arch repair for ATAD were included. Perioperative characteristics, operative outcomes, and overall survival were evaluated. Additionally, surgical outcomes over time were compared.

Results: In all, 2542 patients underwent ascending and arch repair, of whom 490 received a total arch replacement. Redo total arch replacement after limited arch repair for ATAD was performed on 101 patients. Emergent surgery was required in 5 (5%). Retrograde cerebral perfusion was utilized in 93 (92.1%). Profound/deep hypothermia was used in 36 (78%). Operative mortality was 6.9% (7 patients). Postoperative stroke occurred in 6.9%, and spinal cord injury occurred in 3.0%. Overall survival was 64.0% at 5 years and 57.9% at 10 years. There was improvement in operative mortality over time, though statistically insignificant (P = .059).

Conclusions: Surgical outcomes of redo total arch replacement after limited arch repair for ATAD have been acceptable and shown dramatic improvement over the past decades.