Predictors for Late Reoperation After Surgical Repair of Acute Type A Aortic Dissection

It is impossible to resolve all the problems of the entire diseased aorta with just one operation for acute type A aortic dissection, which requires additional surgical treatment in the long-term.

From April 2004 to March 2017, 310 patients underwent surgical repair for acute type A aortic dissection at our institution. Of these, 32 (10.3%) died in the hospital. Of the 278 hospital survivors, 38 underwent late reoperation associated with aortic dissection during the follow-up period. We compared the 240 nonreoperation patients and the 38 reoperation patients to analyze risk factors for late reoperation after operations for acute type A dissection.

The mean duration from the initial operation to reoperation was 3.54 ± 3.0 years. The rates of actuarial freedom from reoperation were 96.9%, 83.2%, and 64.2% at 1, 5, and 10 years, respectively. The multivariate Cox proportional hazard regression analysis revealed the following as independent predictors of late reoperation: younger age, Marfan syndrome, nonprescription of β-blockers, greater diameter of the descending aorta, ratio of false lumen to true lumen of more than 1, limb malperfusion, and primary entry in the ascending aorta. Log-rank analysis revealed no difference in long-term survival between the two groups.

We found several risk factors for both late reoperation and death. Specifically, aortic diameter in the early phase after the initial operation and nonuse of β-blockers were strong predictors. The ratio of the false lumen to the true lumen may also be a new and useful indicator for late reoperation.