Secondary Open Surgery for Type a Aortic Dissection Following Thoracic Endovascular Aortic Repair

This study aims to evaluate the clinical features, surgical techniques, and outcomes of patients who developed type A aortic dissection (TAAD) after undergoing thoracic endovascular aortic repair (TEVAR).

From January 2018 to April 2024, 31 consecutive patients who developed ascending aortic dissection following TEVAR underwent secondary open arch surgery. Postoperative mortality and morbidity were analyzed to evaluate the immediate and midterm results. Survival analysis during the follow-up was evaluated using a Kaplan-Meier survival curve.

The patients had a mean age of 52.1 ± 10.7 years, and the median interval between TEVAR and TAAD repair was 3 months. All patients underwent aortic arch reconstruction using the frozen elephant trunk (FET) technique, with 25 patients receiving separate grafts and 6 undergoing the modified island technique. The mean durations of the operation, cardiopulmonary bypass, aortic cross-clamp, and hypothermic circulatory arrest were 475.5 ± 95.9 minutes, 252.3 ± 55.2 minutes, 132.9 ± 34.7 minutes, and 21.4 ± 8.8 minutes, respectively. The in-hospital mortality rate was 6.5% (2 of 31 patients). No cases of reoperation for bleeding, spinal cord injury, or cerebral complications were observed. Three patients required hemodialysis due to elevated serum creatinine. Follow-up data were available for 29 survivors, with a mean follow-up period of 43.3 ± 19.2 months (range, 3 to 79 months). Three patients were lost to follow-up, and one patient died during the follow-up period.

Aortic arch reconstruction using the FET technique is a safe and effective treatment option for patients with TAAD following TEVAR, offering acceptable early and midterm outcomes.