Key result
Concomitant aortic arch replacement during reoperative root replacement yielded equivalent estimated 5-year survival compared to isolated proximal repairs (81.8% vs 80.6%).
Why the study?
Surgical outcomes for patients undergoing reoperative root replacement after previous acute type A dissection repair are unknown.
Does reoperative full aortic root replacement after previous acute type A dissection repair yield acceptable surgical and mid-term survival outcomes?
Cohort (n=57)
No
Does reoperative full aortic root replacement after previous acute type A dissection repair yield acceptable surgical and mid-term survival outcomes?
Absolute Event Rate: 81.8% vs 80.6%
Reoperative aortic root replacement after previous type A dissection repair can be performed with acceptable mortality (7.0%) and good mid-term survival, even when concomitant arch or coronary reconstruction is required.
May favor full root replacement in acute type A dissection to reduce reoperations; leaves open reoperative risk quantification pending prospective data.
Limited aortic root repair for acute type A dissection is associated with greater risk of proximal reoperations compared to full aortic root replacement. Surgical outcomes for patients undergoing reoperative root replacement after previous dissection repair are unknown. This study seeks to determine outcomes for these patients to further inform the debate surrounding optimal upfront management of the aortic root in acute dissection. Retrospective record review of all patients who underwent full aortic root replacement after a previous type A dissection repair operation at a tertiary academic referral center from 2004-2020 was performed. Among 57 cases of reoperative root replacement after type A repair, 35 cases included concomitant aortic arch replacements, and 21 cases involved coronary reconstruction (unilateral or bilateral modified Cabrol grafts). There were 3 acute postoperative strokes and 4 operative mortalities (composite 30-day and in-hospital deaths, 7.0%). Mid-term outcomes were equivalent for patients who required arch replacement compared to isolated proximal repairs (81.8% vs 80.6% estimated 5-year survival, median follow-up 5.53 years. Reoperative root replacement after index type A dissection repairs, including those with concomitant aortic arch replacement and/or coronary reconstruction is achievable with acceptable outcomes at an experienced aortic center.
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Pedroza et al. (2023) conducted a cohort in Previous acute type A dissection repair requiring reoperative aortic root replacement (n=57). Concomitant aortic arch replacement during reoperative root replacement vs. Isolated proximal repairs was evaluated on Estimated 5-year survival. Concomitant aortic arch replacement during reoperative root replacement yielded equivalent estimated 5-year survival compared to isolated proximal repairs (81.8% vs 80.6%).
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