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.
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.
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).
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