Open arch surgery in the redo setting: contemporary outcomes

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Redo aortic arch reconstruction is complex, particularly after prior proximal aortic surgery.
• Traditional open reconstruction is common but shows variable outcomes.
• This study details institutional adaptations and outcomes in the modern era.

Purpose of the Study:

• To describe institutional adaptations in surgical technique and perioperative care for redo aortic arch repair.
• To assess operative and long-term outcomes of redo aortic arch repair in the modern era.

Main Methods:

• Analysis of 214 patients undergoing hemi- or total arch reconstruction after prior cardiac surgery (2005-2022).
• Strategic adaptations included Type II hybrid arch repair for "mega-aorta," redo-cannulation of the axillary artery, and adoption of transfusion/early extubation protocols.
• Outcomes assessed: 30-day/in-hospital adverse events, long-term overall and aorta-specific survival.

Main Results:

• The cohort included 214 patients; 72% underwent hemi-arch, 28% total arch repair.
• Indications included degenerative aneurysm (47%), residual dissection (29%), and acute/chronic dissection (18%).
• 30-day/in-hospital mortality was 6%, stroke 3%. 5-year overall survival was 76%, 5-year aorta-specific survival was 91%.

Conclusions:

• A systematic approach to redo-arch repair yields excellent operative outcomes and late aorta-specific survival.
• Reduced late overall survival is attributed to the population's comorbidity burden.
• Open reconstruction remains crucial for reoperative aortic arch repair.