Late Reoperations After Repair of Acute Type A Aortic Dissection

P>Background: Regarding surgical interventions for type A acute aortic dissection (AAD), it is currently unclear if an initial, less invasive approach followed by later reoperations is safer than an extended approach aimed at preventing future reinterventions. We retrospectively reviewed our surgical cases to clarify the safety of late reoperation after repair of acute AAD. Methods: Since 2004, 17 patients (eight female; mean age: 64.1 +/- 9.3 years) of all 115 AAD cases in our institute underwent reoperations after initial repair of acute AAD, and operative factors were evaluated. Results: Anastomotic pseudoaneurysms were the main reason for reoperation; one distal, seven proximal, and two both. Seven patients required surgical reintervention because of aneurysmal dilatation of the remaining aorta. The duration between the initial and late operations was 6.4 +/- 5.1 years in the anastomotic pseudoaneurysm group and 4.6 +/- 4.5 years in the recurrence group. In the anastomotic pseudoaneurysm group, there were three root replacements, four resuspensions of the aortic valve, and two aortic valve replacements. Six patients required replacement of the aortic arch. Total arch replacement was the most frequent operation in the recurrence group. Three patients who required sternum reentries underwent concomitant right thoracotomies to dissect adhesions between the sternum and the aneurysm. There were no mortalities. Conclusions: Although most cases required extended procedures for late reoperation after repair of acute AAD, reoperations can be performed safely by careful choice of appropriate operative methods and strategies. Our data suggest that ascending aortic replacement is an effective initial procedure for patients with acute AAD. (J Card Surg 2010;25:208-213).