Late Reoperations After Repair of Acute Type A Aortic Dissection

Abstract

Although most cases required extended procedures for late reoperation after repair of acute AAD, reoperations can be performed safely by careful choice of appropriate operative methods and strategies. Our data suggest that ascending aortic replacement is an effective initial procedure for patients with acute AAD.

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

“…Zero percent to 14% hospital mortality and 8% to 21% long-term mortality have been reported in other series [22][23][24][25], but these series had very small patient cohorts (n ¼ 24, 21, 19, and 17) and even smaller numbers of patients who underwent procedures involving replacement of the entire arch. Of interest, in our series, full arch replacement versus hemiarch replacement was not significantly associated with either operative or long-term mortality (p ¼ 0.54 and 0.28, respectively).…”

Low Incidence of Late Pseudoaneurysm and Reoperation After Conventional Repair of Acute Type A Aortic Dissection

“…Dissection was considered acute when treated within 14 days from the onset of symptoms. Pseudoaneurysm was defined as a localized hematoma or false aneurysm at the proximal or distal suture lines . Reoperation included any cardiac or vascular surgical intervention with an indication that could be related to complications occurring in the segments of aorta involved in the initial repair of AAD or to complications stemming from the spontaneous evolution of the dissection at sites not treated in the initial operation.…”

“…Thus the need for late reoperation remains fairly common after AAD repair . Several retrospective studies have reported the incidence and mechanisms of late reoperation . However, the results were usually affected by use of several different surgical techniques and involvement of many cardiac surgeons …”

“…Suture line dehiscence and pseudoaneurysm formation is one of the leading causes of late reoperation after AAD repair . Several surgical techniques have been introduced for a more secure aortic anastomosis.…”

“…However, the long‐term efficiency of each sandwich technique is unknown . Controversy still remains about whether different surgical techniques can affect the need for late reoperation . A sandwich technique should prevent suture line dehiscence and pseudoaneurysm formation .…”