Redo surgery in ascending aorta and aortic arch.

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Surgery
• Aortic Arch Repair

Background:

• Reinterventions for ascending aorta and aortic arch repair present significant technical challenges.
• These complex procedures are associated with high morbidity and mortality rates.

Purpose of the Study:

• To present a single-center experience in managing reoperations for ascending aorta and aortic arch pathology.
• To evaluate different surgical approaches for treating complex aortic reinterventions.

Main Methods:

• Retrospective review of a prospectively maintained database of thoracic aortic procedures.
• Analysis of 17 patients who underwent ascending aorta and aortic arch redo surgery between 1999 and 2014.

Main Results:

• The in-house reintervention rate was 6.9% (13/188), with stent-graft migration being a common indication.
• Endovascular relining and hybrid repairs were used for migration, while complex dissections and pseudoaneurysms required surgical replacement under deep hypothermic circulatory arrest (DHCA) and antegrade cerebral perfusion (ACP).
• No 30-day mortality was observed, but major morbidities included paraplegia, stroke, bleeding, and respiratory failure.

Conclusions:

• Reinterventions following ascending aorta or aortic arch repair are not uncommon and carry significant risks.
• Redo surgery for these conditions is feasible in high-volume, experienced centers, often necessitating hybrid approaches or surgical replacement under DHCA and ACP.