Early and Late Outcomes of Redo Procedure for Total Arch Replacement After Previous Cardiovascular Surgery: 10-Year Experience.

Objectives: To evaluate the early and late outcomes of the redo procedure for total arch replacement following previous cardiovascular surgery.

Methods: Between January 2013 and November 2023, 117 patients underwent total aortic arch replacement after previous cardiovascular surgery in our centre. Surgical indication, perioperative data, postoperative complications, and late outcomes were retrospectively analysed.

Results: The mean age of patients was 46.8 ± 13.0 years, and 32 were female (27.4%). Indications for redo procedure included aortic arch aneurysm (11, 9.4%), aneurysmal expansion of a chronic dissection (35, 29.9%), staged surgery in plan (3, 2.6%), aortitis (2, 1.7%), and iatrogenic reasons (16, 13.7%). In-hospital mortality was 6.8% with 13.7% major adverse events. Patients who received bilateral cerebral perfusion had significantly higher intraoperative temperatures [nasopharyngeal: 23.4°C (20.4°C-25.0°C) vs 26.8°C (25.0°C-27.5°C), P < .001; bladder: 25.5 ± 3.2°C vs 28.8 ± 1.8°C, P < .001] and required fewer platelet transfusions [median units: 1.0 (1.0-2.0) vs 1.00 (1.0-1.0), P = .003], with no significant differences in postoperative neurological deficits. Overall survival of the patients was 90.1% [95% confidence interval (CI): 84.2%-96.5%], 86.9% (95% CI: 79.8%-94.6%), and 80.0% (95% CI: 70.5%-90.8%) at 1, 3, and 5 years, respectively. During follow-up, 14 patients received aortic-related reintervention. The cumulative incidence of reintervention was 17.20% (95% CI: 7.22%-26.11%) at 5 years.

Conclusions: Although redo total arch replacement is technically challenging, acceptable early and late results can be obtained through tailored surgical planning and end-organ protection.