Aortic root and total arch replacement in a patient with prior ascending aortic repair for type-A aortic dissection

A 63-year-old man was admitted to our hospital owing to the shortness of breath. He had undergone ascending aortic repair for acute type-A aortic dissection 14 years ago. In the previous surgery, the primary entry of the ascending aorta had been resected using direct end-to-end anastomosis after transecting the ascending aorta at the level of the entry and gluing the false lumen using a gelatin-resorcin-formalin glue. The anastomosis site on the ascending aorta had been reinforced using Teflon felt strips. The patient developed heart failure owing to severe aortic regurgitation caused by aortic root dilatation. Since the aortic arch was also dilated, he underwent aortic arch and root replacement. The distinctive difficulties experienced during surgery owing to the prior ascending aortic direct repair have been highlighted in this report.