Reoperation after Type A Dissection Repair

Acute type A dissection is the most taxing of cardiovascular emergencies.The extent of dissection and fragility of the aortic wall may pose difficulties during and after primary repair.Even those with an interest in the aorta are unlikely to treat more than 10 cases per year and there is no consensus regarding the optimum surgical approach.Treatment options range from localized repair of the ascending aorta with a crossclamp in place (whether or not the tear is found) to complete root and arch replacement.The introduction of biological glues in Europe has resulted in a preference for aortic valve preservation, rather than the more radical alternative of aortic root replacement.'Recently, excessive use of Gelatin Resorcine Formol (GRF) glue has been suspected to cause tissue necrosis.Nevertheless, hospital survival is the prime objective in this high risk condition and less radical procedures are associated with lower surgical mortality.*Our approach is therefore to perform aortic root replacement only in patients with the Marfan and Elhers-Danlos syndromes.We attempt to repair the root and conserve the valve in all other cases.A number of different pathological processes may lead to reoperation.Ineffective resuspension of the native aortic valve results in persistent aortic regurgitation and the need for valve replacement.