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OC20 EARLY AND LONG-TERM RESULTS OF LATE REOPERATION AFTER REPAIRED ACUTE TYPE A AORTIC DISSECTION

Piani, D.1; Vendramin, I.1; Lechiancole, A.1; Ferrara, V.1; Meneguzzi, M.1; Sponga, S.1; Livi, U.1

Journal of Cardiovascular Medicine: November 2018 - Volume 19 - Issue - p e2
doi: 10.2459/01.JCM.0000549849.06386.1d
1. ORAL PRESENTATION - AORTA SATURDAY 24 - 08.00-10.00
Free

Background and Aim: Repaired type-A acute aortic dissection (TA-AAD) is a life-threating disease with unpredictable long-term evolution and prognosis. The aim of this study is to analyse causes, timing, and results of reoperation after primary surgery for TA-AAD.

Methods: Between 1977 and 2017, 37 patients (mean age 60 ± 14 years, 86% male) underwent late reoperation for complicated repaired TA-AAD at our Institution. Data was collected and analysed retrospectively.

Results: Mean time of late reoperation was 64 ± 70 months. First procedures were ascending aorta±emiarch replacement in 30 patients (7 AVR, 1 valve sparing) and ascending aorta + arch surgery in 7 patients (2 AVR, 1 valve sparing). In-hospital mortality was 5.4% (1 patient for infection and 1 for haemorrhagic shock). Overall survival was 86.1 ± 5.8 at 1 year, 68.8 ± 8.4% at 5 years, with a mean follow-up of 53 ± 50 months. Indications for redo-surgery were: pseudoaneurysm of the bulb/residual ascending aorta (12), chronic dissection of the arch/descending aorta (21), severe aortic insufficiency (4). Six patients (86%) previously operated for total arch replacement underwent TEVAR as staged procedure (0% mortality) and 11 patients (37%) previously operated of ascending aorta±emiarch underwent total arch replacement (none in-hospital death).

Conclusions: In our experience surgical reoperation for repaired acute type-A aortic dissection can be safely performed and offers good results even in the long-term. Furthermore, the endovascular approach, as part of a staged procedure for the treatment of residual descending aortic dissection, allows to achieve excellent long-term outcome with low operative risk.

1Cardiothoracic Department University Hospital of Udine Udine

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