Editor's Choice – Aortic Re-operation After Replacement of the Proximal Aorta: A Systematic Review and Meta-Analysis

Abstract

Aortic re-operation occurs at a mean rate of 2.4% per person-year in the five years after proximal aortic replacement and is strongly associated with initial operation for dissection.

Technical eligibility for endovascular treatment of the aortic arch after open type A aortic dissection repair

“…It is evident that patients treated for an aortic dissection sustain a considerable risk of need for future aortic reintervention. 1,2,13 The present study reiterates this risk, with almost 20% of the surviving patients undergoing some form of aortic reoperation. Moreover, it confirms that a substantial number of patients (14.7%) ultimately meet the conventional threshold diameter for aortic arch repair of 55 mm.…”

“…For those patients successfully treated, approximately 10-15% will require reintervention within the next five years, including repair of the arch and descending thoracic aorta due to aneurysmal degeneration of the chronically dissected aorta. [1][2][3][4] There is still some debate regarding the optimal initial surgical technique, balancing more extensive aortic arch surgery with its inherent risks against a potential reduction of distal dilatation and need for reoperation. 5,6 Endovascular treatment of complex aortic arch and descending aortic pathologies has rapidly evolved, however, and the landscape of how post-proximal aortic surgery reoperations can be treated has changed.…”

Prosthetic aortic graft replacement of the ascending thoracic aorta alters biomechanics of the native descending aorta as assessed by transthoracic echocardiography

“…ultimately respond differently to altered distending forces induced by a prosthetic graft, resulting in differences in clinical outcomes. Further longitudinal research in larger cohorts is needed to test these concepts [3][4][5][6][7][8].…”

“…Prosthetic graft replacement is a well-established interventional therapy for patients with ascending thoracic aortic aneurysms (AA), in whom it provides potential lifesaving benefits and is recommended by consensus guidelines [1,2]. While graft replacement eliminates risk for dilatation or dissection in surgically replaced regions, event risk persists in non-grafted areasespecially in patients with genetically associated aortopathies [3][4][5][6][7]. Nearly 50% of type B dissections in patients with Marfan syndrome occur in context of prior prophylactic graft surgery [5,6].…”

Technical Aspects of Branched Thoracic Arch Graft Implantation for Aortic Arch Pathologies

“…However, open repair requires a complex setup, cardiopulmonary bypass, deep hypothermic circulatory arrest, and antegrade cerebral perfusion techniques and carries significant morbidity and mortality, 5 especially after previous open repair. 6 The operative risk of open repair of aortic arch disease is greater in urgent cases, elderly patients, and in those with preexisting comorbidities and previous open repair. Those patients may be deemed unsuitable for open repair and even be denied an operation.…”