Late reoperations after repaired acute type A aortic dissection

Kobuch, Reinhard; Hilker, Michael; Rupprecht, Leopold; Hirt, Stephan; Keyser, Andreas; Puehler, Thomas; Amman, Matthias; Zink, Wolfgang; Schmid, Çhristof

doi:10.1016/j.jtcvs.2011.08.052

Cited by 74 publications

(73 citation statements)

References 18 publications

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“…Similar to early reports, aneurysmal progression of the false lumen is the most common reason for re-operation in our series (18,19). Although reoperations can be challenging and significantly increase potential morbidity and mortality, the trend for most surgeons continues to favor a more limited initial repair with the plan to refer late sequelae to a specialized aortic center at later time (18)(19)(20).…”

Section: Primary Repair and Reoperationsupporting

confidence: 86%

“…Disease progression after conservative repair does not occur immediately (18,21,22). Aortic growth is usually gradual and takes several years before re-operation: 3.5 years in our series, 4.7 years in Concistre's, 5.9 years in Kobuch's, and 7.7 years in Preventza's report (18,21,22). There were more extensive distal repairs in our re-operations group.…”

Section: Primary Repair and Reoperationmentioning

confidence: 48%

“…Leaving residual dissected aorta within the ascending and arch segments in situ will lead to late aneurysmal degeneration (19,20). Disease progression after conservative repair does not occur immediately (18,21,22). Aortic growth is usually gradual and takes several years before re-operation: 3.5 years in our series, 4.7 years in Concistre's, 5.9 years in Kobuch's, and 7.7 years in Preventza's report (18,21,22).…”

Section: Primary Repair and Reoperationmentioning

confidence: 58%

“…Our Cox regression analysis has shown that redo-surgery was slightly protective with fewer patients dying after redo-surgery. All these findings support that complex reoperations for repaired acute TAAD can be performed safely and thus re-operative risk alone should not dictate the operative strategy during the initial TAAD repair (18,21). However, the patients who underwent elective reoperation after previous "incomplete" acute dissection repairs are a very select group, and it is likely that many more patients with dissecting aneurysms are not offered further surgery either because they are not deemed operable or because the patients accept the inevitability of their premature death due to aortic related complications.…”

Section: Primary Repair and Reoperationmentioning

confidence: 71%

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Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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Background: Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated-such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes.Methods: All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method.Results: Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support postoperatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study.Conclusion: TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the short and long term.

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Section: Primary Repair and Reoperationsupporting

confidence: 86%

Section: Primary Repair and Reoperationmentioning

confidence: 48%

Section: Primary Repair and Reoperationmentioning

confidence: 58%

Section: Primary Repair and Reoperationmentioning

confidence: 71%

See 2 more Smart Citations

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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“…Only one major stroke was noted. 9 Neurological dysfunction complicates the course of up to 40% of patients with left heart valvular and perivalvular infection. 10 Nonetheless, a clear management plan for these challenging patients is lacking, and indications for as well as optimal timing of cardiac surgery remain controversial.…”

Section: Commentmentioning

confidence: 99%

Complete graft dehiscence 8 months after repair of acute type A aortic dissection

Gebhard

Biaggi

Stähli

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Acute type A aortic dissection is a dreaded differential diagnosis of acute chest pain. Long-term outcome mainly depends on pre-existing comorbidities and post-operative complications. We present a patient with aortic graft dehiscence and subsequent severe aortic regurgitation due to fungal graft infection 8 months after repair of acute type A aortic dissection. Redo aortic surgery had to be delayed for 28 days due to intracerebral haemorrhage caused by septic embolism and clipping of a mycotic left middle cerebral artery aneurysm. Surgery revealed a circumferentially detached graft at the site of the proximal anastomosis thereby forming a massive pseudoaneurysm. The patient underwent successful aortic root replacement using a Freestyle porcine root bioprosthesis (25 mm), followed by re-anastomosis of the coronary arteries and partial replacement of the ascending aorta with a 28 mm Dacron graft. The patient was discharged on day 67 in stable cardiac condition with persistent neurological deficits. This case highlights the challenging management of patients with aortic graft infection and neurological dysfunction after redissection of the ascending aorta who require redo cardiac surgery.

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Rationale for a Conservative Approach and Arguments Against Aggressive Surgical Approaches

Sastry

Large

2014

Controversies in Aortic Dissection and Aneurysmal Disease

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Late reoperations after repaired acute type A aortic dissection

Abstract: Complex reoperations for repaired acute type A dissection can be performed safely. The concern for the reoperative risk should not dictate the operative strategy during the initial procedure in acute type A dissection.

Cited by 74 publications

References 18 publications

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Complete graft dehiscence 8 months after repair of acute type A aortic dissection

Rationale for a Conservative Approach and Arguments Against Aggressive Surgical Approaches

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