190 * REDO AFTER ACUTE TYPE A AORTIC DISSECTION: EARLY RESULTS FROM A MULTICENTRE REAL-WORLD EXPERIENCE

Abstract

Objectives: To provide early results of repetitive surgical procedures after first operation for acute type A aortic dissection (AAD) and to identify risk factors for mortality. Methods: Between May 1998 and January 2014, 117 aortic reoperations after initial operation for AAD (mean time from the first procedure was 3.98 years, range 0.1–20.87) were performed in 110 patients (mean age 59.8 ± 12.6 years) in 7 real-world institutions. Proximal causes for reoperation were aortic root aneurysm in 20, root re-dissection in 17, aortic valve insufficiency in 27 and proximal anastomotic pseudoaneurysm in 26 patients. Distal causes were arch re-dissection in 18, arch dilatation in 15, anastomotic pseudoaneurysm in 25 patients. Results: A total of 74 isolated proximal, 30 isolated distal and 13 combined procedures were performed. There were 23 (19.66%) in-hospital deaths (elective/urgent 11.11%, emergency 66.67%). Causes of death were cardiac in 8, neurological in 3, multiorgan failure in 5, sepsis in 2, bleeding in 3 and lung failure in 2 patients. Multivariate logistic regression analyses revealed that risk factors for mortality were emergency operation (P < 0.0001), previous distal procedure (P = 0.04) and new elephant trunk procedure (P = 0.03). New proximal procedures were not found to be risk factors for early mortality (P = 0.15). Conclusion: This multicentre experience shows that redo surgery after AAD operations remains a challenging procedure especially in emergency settings and after surgery of the distal aorta. Proximal reoperation does not affect mortality; therefore initial aortic root preservation for AAD should not be considered a concern for late reoperations.