Abstract 19436: Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy
Introduction: The optimal surgical approach for management of acute Type A aortic dissection remains controversial. Arguments in favor of limited index repair include higher operative risk associated with more extensive (e.g. total arch) repair, while arguments in favor of extended repair include concerns regarding outcomes of reoperation. This study aimed to assess outcomes of reoperation after acute Type A dissection repair to guide decision-making around initial operative strategy.
Methods: All patients (n = 90) who underwent reoperation (n = 127 procedures) at a single referral institution from 08/2005 to 04/2016 after prior acute Type A dissection repair were reviewed. The primary outcome was 30-day/in-hospital mortality. Secondary outcomes included organ-specific morbidity, and one and five-year outcomes as estimated using Kaplan-Meier method.
Results: The median interval between index Type A repair and first reoperation was 5 years. The majority of reoperations were proximal aortic (aortic valve, aortic root, or ascending) or aortic arch procedures (67%, n = 85, Table); most reoperations were performed in the elective setting (85%, n = 108). Thirty-day mortality was 7.9% (elective: 6.5%, non-elective: 16%) with low rates of organ-specific morbidity. Additional non-staged reoperations were required in 19 patients after the first reoperation, the vast majority (15/19; 79%) of which were distal aortic procedures, during a median follow-up of 2.5 years. One- and five-year survival after initial reoperation was 80% and 62%, respectively.
Conclusions: Reoperation after acute Type A aortic dissection repair in the elective setting is associated with low rates of mortality and morbidity. Long-term survival was acceptable and the incidence of needing additional procedures was low. These data support use of a more limited index repair for acute Type A dissection as elective reoperations, if needed, can be performed safely in referral aortic centers.
Author Disclosures: H. Wang: None. E. Benrashid: None. J. Keenan: None. D. Ranney: None. B. Yerokun: None. A. Wang: None. J. Gaca: None. G. Hughes: None.
- © 2016 by American Heart Association, Inc.