Reoperative surgery on the thoracic aorta.

Area of Science:

• Cardiovascular Surgery
• Thoracic Aorta Surgery
• Aortic Disease Management

Background:

• Reoperations on the thoracic aorta are complex procedures following initial aortic surgery.
• The frequency of thoracic aorta reinterventions has significantly increased over time.
• Indications for reoperation include degenerative aneurysms, postdissection issues, false aneurysms, and prosthetic infections.

Purpose of the Study:

• To report hospital and long-term outcomes of reinterventions on the thoracic aorta.
• To identify predictors of mortality in patients undergoing thoracic aorta reoperations.
• To evaluate survival and reoperation rates after thoracic aorta reinterventions.

Main Methods:

• A retrospective review of 224 reoperations on the proximal thoracic aorta between 1986 and 2011.
• Analysis of patient demographics, indications for surgery, and surgical procedures performed.
• Multivariate analysis to identify independent predictors of hospital mortality.

Main Results:

• Hospital mortality was 12.1%, with cardiopulmonary bypass time and urgent/emergency status as independent predictors.
• Estimated 1-, 5-, and 10-year survival rates were 84.4%, 72.5%, and 48.5%, respectively.
• Freedom from reoperation at 1, 5, and 10 years was 95.6%, 90.2%, and 81.5%, with most reoperations due to downstream aortic disease progression.

Conclusions:

• Reoperative aortic surgery demonstrates acceptable short- and long-term results, especially when performed electively.
• The extent of aortic replacement during reoperation did not affect survival but was linked to fewer reinterventions.
• Aggressive aortic resections during initial surgery are suggested due to the progressive nature of aortic disease and favorable elective outcomes.