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Is previous cardiac surgery a risk factor for open repair of acute type A aortic dissection?

Elizabeth L Norton1, Carlo Maria Rosati2, Karen M Kim2

  • 1Creighton University School of Medicine, Omaha, Neb.

The Journal of Thoracic and Cardiovascular Surgery
|October 6, 2019
PubMed

Insights

Patients with previous cardiac surgery undergoing repair for acute type A aortic dissection had similar operative outcomes but lower long-term survival. Surgical treatment remains recommended for this complex patient group.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease Management

Background:

  • Acute type A aortic dissection (aTAAD) in patients with prior cardiac surgery presents unique management challenges.
  • Optimal treatment strategies for this high-risk population require careful consideration of operative and long-term outcomes.

Purpose of the Study:

  • To determine the optimal treatment for patients experiencing acute type A aortic dissection subsequent to previous cardiac surgery.
  • To compare outcomes of aTAAD repair in patients with and without prior cardiac surgery.

Main Methods:

  • Retrospective analysis of 545 patients undergoing open repair for aTAAD between July 1996 and January 2017.
  • Data sourced from the University of Michigan Cardiac Surgery Data Warehouse, medical records, and the National Death Index.
  • Patient cohorts were stratified into those with (n=50) and without (n=495) previous cardiac surgery.

Main Results:

  • Patients with prior cardiac surgery were older and had more comorbidities, including coronary and peripheral arterial disease, and connective tissue disorders.
  • Despite longer bypass times and more transfusions, there were no significant differences in major postoperative complications or 30-day mortality between groups.
  • While operative mortality was not significantly increased by prior surgery, 5- and 10-year unadjusted survival rates were lower in the prior surgery group.

Conclusions:

  • Acute type A aortic dissection repair in patients with previous cardiac surgery can achieve favorable operative mortality.
  • Long-term survival in this cohort is reduced, but surgical intervention is still recommended.
  • Previous cardiac surgery is not a significant independent risk factor for operative or all-cause mortality.
Abstract

Keywords:
aortic dissectionlong-term survivaloperative mortalityprevious cardiac surgery

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