Aortic arch surgery after previous type A dissection repair: Results up to 5 years

Pietro Bajona, Eduard Quintana, Hartzell V Schaff, Richard C. Daly, Joseph A. Dearani, Kevin L. Greason, Alberto Pochettino

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECTIVES Open aortic arch surgery after type A dissection repair is challenging. We sought to review our surgical experience to analyse the causes and timing, establish the risk profile for this patient population, and better define outcomes. METHODS From 2000 to 2014, we identified 55 patients who required aortic arch surgery after a previous type A dissection repair. Medical records were available for review including computerized tomographic angiograms, cerebral protection strategies and follow-up. RESULTS The mean interval from previous type A dissection repair to aortic arch surgery was 5.7 ± 5.4 years. At reoperation 36 patients (65%) had total arch replacement and 19 (35%) had hemiarch replacement. Indications for reoperations were: enlarging aneurysm in 27 (49%), impending rupture in 12 (22%), chronic dissection in 10 (18%) and aneurysms in 6 (11%). Arterial peripheral cannulation was used in 80% of patients. Selective antegrade cerebral perfusion was used in 35 patients (64%) and retrograde perfusion in 2 (4%). There were 3 perioperative deaths (5%) and 4 cases of permanent stroke (7%). Survival rates were 90, 85 and 77% at the 1-, 3- and 5-year follow-up, respectively. The 5-year survival rate was 10% lower than that of an age- and sex-matched population (P < 0.001). The only predictor of the follow-up mortality was older age (odds ratio: 1.07, 95% confidence interval: 1.02-1.13, P = 0.007). CONCLUSIONS Aortic arch surgery after previous type A dissection repair can be performed with satisfactory early and mid-term results and acceptable risk of stroke. Cerebral perfusion strategies likely contribute to positive outcomes. Favourable mid-term survival justifies performing such difficult reoperations.

Original languageEnglish (US)
Pages (from-to)81-86
Number of pages6
JournalInteractive Cardiovascular and Thoracic Surgery
Volume21
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Thoracic Aorta
Dissection
Reoperation
Perfusion
Aneurysm
Survival Rate
Stroke
Catheterization
Population
Medical Records
Rupture
Angiography
Odds Ratio
Confidence Intervals
Survival
Mortality

Keywords

  • Aortic arch reoperation
  • Cerebral protection
  • Type A dissection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Aortic arch surgery after previous type A dissection repair : Results up to 5 years. / Bajona, Pietro; Quintana, Eduard; Schaff, Hartzell V; Daly, Richard C.; Dearani, Joseph A.; Greason, Kevin L.; Pochettino, Alberto.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 21, No. 1, 01.07.2015, p. 81-86.

Research output: Contribution to journalArticle

Bajona, Pietro ; Quintana, Eduard ; Schaff, Hartzell V ; Daly, Richard C. ; Dearani, Joseph A. ; Greason, Kevin L. ; Pochettino, Alberto. / Aortic arch surgery after previous type A dissection repair : Results up to 5 years. In: Interactive Cardiovascular and Thoracic Surgery. 2015 ; Vol. 21, No. 1. pp. 81-86.
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AU - Bajona, Pietro

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AU - Daly, Richard C.

AU - Dearani, Joseph A.

AU - Greason, Kevin L.

AU - Pochettino, Alberto

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N2 - OBJECTIVES Open aortic arch surgery after type A dissection repair is challenging. We sought to review our surgical experience to analyse the causes and timing, establish the risk profile for this patient population, and better define outcomes. METHODS From 2000 to 2014, we identified 55 patients who required aortic arch surgery after a previous type A dissection repair. Medical records were available for review including computerized tomographic angiograms, cerebral protection strategies and follow-up. RESULTS The mean interval from previous type A dissection repair to aortic arch surgery was 5.7 ± 5.4 years. At reoperation 36 patients (65%) had total arch replacement and 19 (35%) had hemiarch replacement. Indications for reoperations were: enlarging aneurysm in 27 (49%), impending rupture in 12 (22%), chronic dissection in 10 (18%) and aneurysms in 6 (11%). Arterial peripheral cannulation was used in 80% of patients. Selective antegrade cerebral perfusion was used in 35 patients (64%) and retrograde perfusion in 2 (4%). There were 3 perioperative deaths (5%) and 4 cases of permanent stroke (7%). Survival rates were 90, 85 and 77% at the 1-, 3- and 5-year follow-up, respectively. The 5-year survival rate was 10% lower than that of an age- and sex-matched population (P < 0.001). The only predictor of the follow-up mortality was older age (odds ratio: 1.07, 95% confidence interval: 1.02-1.13, P = 0.007). CONCLUSIONS Aortic arch surgery after previous type A dissection repair can be performed with satisfactory early and mid-term results and acceptable risk of stroke. Cerebral perfusion strategies likely contribute to positive outcomes. Favourable mid-term survival justifies performing such difficult reoperations.

AB - OBJECTIVES Open aortic arch surgery after type A dissection repair is challenging. We sought to review our surgical experience to analyse the causes and timing, establish the risk profile for this patient population, and better define outcomes. METHODS From 2000 to 2014, we identified 55 patients who required aortic arch surgery after a previous type A dissection repair. Medical records were available for review including computerized tomographic angiograms, cerebral protection strategies and follow-up. RESULTS The mean interval from previous type A dissection repair to aortic arch surgery was 5.7 ± 5.4 years. At reoperation 36 patients (65%) had total arch replacement and 19 (35%) had hemiarch replacement. Indications for reoperations were: enlarging aneurysm in 27 (49%), impending rupture in 12 (22%), chronic dissection in 10 (18%) and aneurysms in 6 (11%). Arterial peripheral cannulation was used in 80% of patients. Selective antegrade cerebral perfusion was used in 35 patients (64%) and retrograde perfusion in 2 (4%). There were 3 perioperative deaths (5%) and 4 cases of permanent stroke (7%). Survival rates were 90, 85 and 77% at the 1-, 3- and 5-year follow-up, respectively. The 5-year survival rate was 10% lower than that of an age- and sex-matched population (P < 0.001). The only predictor of the follow-up mortality was older age (odds ratio: 1.07, 95% confidence interval: 1.02-1.13, P = 0.007). CONCLUSIONS Aortic arch surgery after previous type A dissection repair can be performed with satisfactory early and mid-term results and acceptable risk of stroke. Cerebral perfusion strategies likely contribute to positive outcomes. Favourable mid-term survival justifies performing such difficult reoperations.

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