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Aortic dissection after previous cardiovascular surgery

Hitoshi Hirose1, Lars G Svensson, Bruce W Lytle

  • 1Center for Aortic Surgery and Marfan and Connective Tissue Disorder Clinic and Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

The Annals of Thoracic Surgery
|November 25, 2004
PubMed

Insights

Repairing aortic dissection after prior heart surgery is feasible, offering acceptable risks and good long-term survival. Subsequent aortic reoperations are infrequent, indicating successful initial management.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease Management

Background:

  • Outcomes of aortic dissection repair following previous cardiovascular surgery are not well-defined.
  • This study evaluates the early and late results of reoperations for aortic dissection in patients with a history of cardiovascular surgery.

Purpose of the Study:

  • To assess the safety and efficacy of reoperations for aortic dissection in patients with prior cardiovascular surgery.
  • To determine the early and late clinical outcomes, including mortality and reoperation rates.

Main Methods:

  • A retrospective analysis of 108 patients who underwent reoperation for aortic dissection between 1990 and 2002.
  • Patients had a history of various prior cardiovascular surgeries, including coronary artery bypass grafting, valve surgery, and aortic aneurysm repair.
  • Surgical procedures involved ascending aorta repair, aortic valve replacement/repair, aortic root replacement, and aortic arch repair, often utilizing circulatory arrest and retrograde brain perfusion.

Main Results:

  • Hospital mortality was 6%, with stroke, renal failure, and respiratory failure rates of 4%, 2%, and 7%, respectively.
  • Survival rates at 7 years were 53%.
  • Freedom from subsequent aortic reoperation at 7 years was 89%.

Conclusions:

  • Aortic dissection occurring after previous cardiovascular surgery is a rare but manageable condition.
  • Reoperation for aortic dissection in this patient cohort can be performed with acceptable operative risks.
  • Good long-term survival can be achieved, and the need for further aortic reoperations is uncommon.
Abstract

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