Late Aortic Reinterventions After Surgery for Acute Type A Aortic Dissection

BACKGROUND: This study was conducted to outline patterns, prevalence, and outcomes of aortic reinterventions after surgical repair for acute type A aortic dissection (ATAAD) and to identify factors associated with proximal and distal aortic reinterventions. METHODS: All patients (n = 225) undergoing surgical ATAAD repair at a single center at least 10 years ago (2005-2013) were included. All aortic reinterventions were reported. A Fine-Gray multivariable model, treating death and contraindication as competing risks, was used to investigate factors associated with aortic reintervention. RESULTS: Median follow-up time was 10.3 years (interquartile range, 5.0-13.4 years). Thirty-seven patients underwent ≥1 aortic reintervention at median 7.9 years (up to 15 years) after the index procedure. Factors associated with proximal aortic reintervention were root diameter >45 mm without root replacement at index repair (subhazard ratio [SHR], 6.9l; 95% CI, 1.8-27; P = .005), bicuspid aortic valve (SHR, 8.4; 95% CI, 1.5-47; P = .016), and age (SHR, 0.93; 95% CI, 0.89-0.98; P = .006). Factors associated with distal aortic reinterventions were failure to completely resect the primary tear (SHR, 2.7; 95% CI, 1.2-6.0; P = .014) and connective tissue disease (SHR, 24; 95% CI, 8.1-72; P < .001). There were no periprocedural deaths at reintervention. Event-free survival at 1, 5, 10, and 15 years was 82% (95% CI, 77%-87%), 72% (95% CI, 65%-77%), 48% (95% CI, 41%-54%), and 33% (95% CI, 26%-40%), respectively. CONCLUSIONS: With sufficient follow-up, event-free survival after ATAAD repair appears substantially impaired. However, in selected patients, aortic reinterventions were performed with favorable outcomes. Replacing a moderately dilated aortic root and ensuring complete resection of the primary tear may decrease the need for future aortic reinterventions.