Indications and outcomes of second aortic procedures after acute type A dissection repair.

Objectives: Aortic arch or aortic root replacement is not performed in all cases of acute type A aortic dissection (ATAD), and a second aortic procedure will become necessary over time for some patients. Indications and outcomes, of second aortic procedures have not been studied extensively.

Methods: Characteristics and in-hospital outcomes of all patients undergoing surgical repair for type A acute aortic dissection were analysed and patients needing second aortic procedure during follow-up were identified. The latter group was divided in 2 subgroups: on-pump includes patients operated on using cardiopulmonary bypass and off-pump without cardiopulmonary bypass.

Results: A total of 638 patients underwent surgery for ATAD; 8% required a second aortic procedure. The most frequent indication for the second aortic procedure was dehiscence of suture lines (44%), followed by arch dilatation (24%). In-hospital mortality was 12%. Isolated ascending aorta replacement at the first surgery was associated with higher incidence of second aortic procedure (P = 0.006). Most patients in the on-pump group underwent a proximal reoperation (75%), with a mortality rate of 14.2%. In-hospital mortality of patients in the off-pump group was 7.7%. Long-term survival analysis showed no difference between groups (P = 0,526), Off-pump patients have greater likelihood of a second intervention during follow-up (P  = 0.004).

Conclusions: Extended aortic root surgery and customized aortic arch repair in ATAD could be reasonable to reduce the incidence and mortality of high-risk second aortic procedures.