Is previous cardiac surgery a risk factor for open repair of acute type A aortic dissection?

Managing Malperfusion Syndrome in Acute Type A Aortic Dissection With Previous Cardiac Surgery

“…Overall our mortality from aortic rupture in patients waiting for delayed open repair has decreased from 16% to 4%, with risk of death from organ failure much higher than the risk of death from rupture. 12 PCS was not a risk factor for in-hospital, operative, or long-term mortality in this study, our previous study, 5 or in other studies in the literature 6 despite more comorbidities on admission and longer cardiopulmonary bypass and aortic cross-clamp times. Therefore the primary issue to address in these patients is MPS.…”

“…The operative strategy in ATAAD patients with or without MPS or PCS was described previously, 1,5,12,14,15 including the strategy of redo sternotomy. 5 Briefly indications for aortic root replacement in ATAAD patients were intimal tear at the aortic root, root diameter ! 4.5 cm, connective tissue disease, and unrepairable aortic valve pathology.…”

“…In this series, the overall inhospital mortality in the MPS cohort was 32% (including a nontrivial interval rupture rate of 8%), which is not appreciably lower than that reported in most other series in the literature. 5 Regardless, it is imperative that surgeons maintain flexibility as outcomes vary considerably based on the type and number of affected organ systems. Moreover, a majority of centers lack the expertise to perform complex endovascular…”

“…1,2 In ATAAD 9% to 16% of patients have had previous cardiac surgery (PCS), which is associated with an increased operative mortality (12-37%). [3][4][5][6][7] Open aortic repair is often more complex and challenging in patients with PCS because of the added risks of sternal reentry and presence of adhesions. ATAAD complicated by malperfusion syndrome (MPS), which is end tissue/organ necrosis and dysfunction due to end-organ malperfusion, is also traditionally treated with emergent open aortic repair and associated with an increased operative mortality (25%-44%).…”

When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review

“…One such study found no significant difference in 30-day morbidity or mortality in 50 patients who had previous cardiac surgery as compared with patients from the same era without earlier surgery. 44 In contrast, in a more recent, much larger study using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from 2002 to 2017, ATAAD repair in patients with previous cardiac surgery was associated with a greater than 2-fold higher risk of mortality compared with patients without previous cardiac surgery (odds ratio, 2.1; P < .01). 45 There was a trend toward decreased operative mortality for patients with previous cardiac surgery who underwent ATAAD repair at high-volume centers (25.7% vs 37.9%; P ¼ .19).…”