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Aortic Reoperation After Prior Acute Type A Aortic Dissection Repair: Don't Despair the Repair

Suguru Ohira1, Ramin Malekan1, Masashi Kai1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.

The Annals of Thoracic Surgery
|January 18, 2023
PubMed

Insights

Reoperation after acute type A aortic dissection (ATAD) repair is safe and effective at experienced centers. Staged distal interventions using the elephant trunk technique offer durable outcomes for patients requiring reoperation after ATAD.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Limited data exists on reoperation outcomes following acute type A aortic dissection (ATAD) repair.
  • Understanding reoperation strategies is crucial for improving long-term patient management.
  • This study addresses the paucity of information on reoperative procedures after ATAD.

Purpose of the Study:

  • To evaluate the safety and efficacy of reoperations after ATAD.
  • To analyze different surgical approaches and their outcomes.
  • To assess long-term survival and freedom from aortic events after reoperation.

Main Methods:

  • Retrospective analysis of 75 patients undergoing 123 reoperations for ATAD between October 2006 and March 2022.
  • Surgical approaches included redo sternotomy (RS), left thoracotomy (LT), and thoracic endovascular aortic repair (TEVAR).
  • Classic elephant trunk technique used for staged distal repairs; axillary artery cannulation prevalent in RS.

Main Results:

  • Low hospital mortality (2.4%) and stroke rate (1.6%) were observed across all reoperation methods.
  • Five-year overall survival was 85.2% ± 5.6%, with 80.6% ± 6.1% freedom from aortic mortality or re-procedure.
  • Staged distal interventions demonstrated durable outcomes with minimal aortic expansion noted on follow-up imaging.

Conclusions:

  • Reoperation for ATAD can be safely performed electively at specialized centers.
  • Staged distal aortic repair using the elephant trunk technique provides durable results.
  • Open repair above the celiac axis is a viable strategy for managing distal ATAD complications.
Abstract

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