Abstract
IntroductionAt present, there are few reports regarding the issue of aortic reoperation due to its complexity and high risk and individual differences among patients.MethodsFrom November 2016 to December 2017, the data from 35 cases of aortic reoperation at our institution, out of 212 consecutive aortic repairs, were reviewed. We retrospectively summarized and analyzed their surgical indications, operative data, time interval from previous aortic repair, and outcomes. The time intervals until reoperation were analyzed for differences.ResultsPatients’ mean age was 40.9±14.5 years, and 25 of them were men (71.4%). The indications for reoperation were aortic valvular problem (14.3%), aneurysmal dilatation (25.7%), pseudoaneurysm formation due to anastomotic leakage (43.2%), and aortic dissection (17.1%). For patients who had underwent primarily emergency operations due to aortic dissection, the time interval until reoperation (4.8±3.2 years) was significantly shorter than that of the whole group (5.5±3.6 years, P<0.01). Among the 35 reoperations, Sun’s procedure was selected for 16 patients (45.7%) with total aortic arch reconstruction. The average follow-up was 12 months (range 9-15 months). Hospital mortality was 5.7% (two patients). Among the hospital survivors there were no cases of death, rupture of residual dissection, paraplegia, or central nervous system complications during the follow-up period.ConclusionPatients with acute aortic dissection required repeat surgery significantly earlier compared to other diseases. As to reoperation strategy, we recommend Sun’s procedure as the choice for extended arch reconstruction since minimal effect on overall mortality and complication rates were found.
Highlights
At present, there are few reports regarding the issue of aortic reoperation due to its complexity and high risk and individual differences among patients
Awareness about reoperation in aortic surgery has increased, and several retrospective studies on aortic reoperation after acute dissection have surfaced in the recent years
Reoperation of the aorta is an issue of great complexity and variability, this is correlated with the diversified techniques used in the first operation, each of which presents with different clinical and anatomical characteristics
Summary
There are few reports regarding the issue of aortic reoperation due to its complexity and high risk and individual differences among patients. During the past 10 years, a better understanding of various aneurysms, continuous improvements of surgical strategies and aortic techniques, and the emergence of new technologies and instruments have diversified the treatment of aortic aneurysms in China. Due to the complexity of aortic disease, which is often multiple and recurrent in nature, aortic reoperation or multiple operations are quite common. Awareness about reoperation in aortic surgery has increased, and several retrospective studies on aortic reoperation after acute dissection have surfaced in the recent years. This study was carried out at the Shanghai Deltahealth Hospital, Shanghai, People’s Republic of China.
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