Proximal Redo after Acute Type A Aortic Dissection: Early Results form a Multicenter Experience

Abstract

Objectives: The aim of this European multicenter-experience was to report on surgical outcomes in terms of mortality and complications of proximal reoperation after intial repair of acute typ A dissection (AAD). Methods: Between May 1998 and January 2014, 71 isolated proximal aortic re-operation (mean time from the first procedure was 3.67 years, range 0.15–16.6) were performed in 66 patients (mean age 60.8 ± 12.4 years, males 50). Proximal causes for re-operation were aortic root aneurysm in 17, root re-dissection in 13, aortic valve insufficiency in 24 and proximal anastomic pseudoaneurysm in 19 patients. Result: The most frequent proximal procedure during redo was the composite aortic root replacement (Bentall procedure) (40 operations, 56.35%), followed by isolated aortic valve replacement (13 pts., 18,31%) and ascending aorta replacement (9 pts., 12,68%). David procedure was performed in 4 patients (5.63%). In-hospital mortality was 14% (10 pts.), of them 7 deaths were reported after emergency operations and 3 in elective or urgent setting. Causes of deaths were cardiac in 5, neurological in 2, MOF in 3. Major adverse event included low output syndrome in 7, neurological complications in 7, acute renal failure 7 and bleeding complications in 10 patients and lung failure in 5 patients. Conclusion: Proximal re-operations can be performed with acceptable in-hospital results. Thus conservative approach of the proximal aorta for AAD should not be considered a concern for late reoperations. Strict follow-up after AAD is mandatory to avoid emergency re-operations.