Aortic Reoperation After Prior Acute Type a Aortic Dissection Repair: Don't Despair the Repair

Authors

Suguru Ohira, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York. Electronic address: suguru.ohira@wmchealth.org.
Ramin Malekan, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
Masashi Kai, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
Joshua B. Goldberg, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
Igor Laskowski, Division of Vascular Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
Corazon De La Pena, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
Ian Mason, New York Medical College, Valhalla, New York.
Steven L. Lansman, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
David Spielvogel, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.

Author Type(s)

Student, Faculty

Journal Title

The Annals of Thoracic Surgery

First Page

43

Last Page

50

Document Type

Article

Publication Date

7-1-2023

Department

Surgery

Abstract

BACKGROUND: There is paucity of data regarding reoperation after acute type A aortic dissection (ATAD) repair. METHODS: From October 2006 to March 2022, 75 patients received 123 reoperations after ATAD (proximal, n = 17; distal, n = 103; and both, n = 3) utilizing redo sternotomy (RS, n = 68), left thoracotomy (LT, n = 44), and endovascular approach (TEVAR, n = 11). The axillary artery cannulation was utilized in 97.1% of the RS cases. A classic elephant trunk technique was used as a 2-staged procedure for distal pathology. Most LT repairs (95.5%) were completed above the celiac axis. RESULTS: Index ATAD repairs were predominantly ascending/hemiarch repair (73.3%). The median duration from the index repair was 2.0 years. Most reoperations were elective procedures (82.1%). Hospital mortality was 2.4% (RS, 1.5%; LT, 4.5%; TEVAR, 0%), and the stroke rate was 1.6%. There was no spinal cord ischemia. The 5-year overall survival and freedom from aortic mortality or procedure were 85.2% ± 5.6% and 80.6% ± 6.1%, respectively. There were 7 distal reinterventions (prior TEVAR, n = 3; prior LT, n = 4). Two patients required LT repair after prior TEVAR and 3 patients received infrarenal aortic repair after prior LT repair. Computed tomography after completion of the distal repair (n = 45) showed an increase of distal aorta at each level as follows: celiac axis 1.2 mm/y; renal artery 1.0 mm/y; and terminal aorta 1.2 mm/y. CONCLUSIONS: Reoperation after ATAD repair can be safely performed as an elective procedure at experienced centers. Staged distal interventions utilizing classic elephant trunk insertion and open repair above the celiac axis showed durable outcomes.

Recommended Citation

Ohira, S., Malekan, R., Kai, M., Goldberg, J. B., Laskowski, I., De La Pena, C., Mason, I., Lansman, S. L., & Spielvogel, D. (2023). Aortic Reoperation After Prior Acute Type a Aortic Dissection Repair: Don't Despair the Repair. The Annals of Thoracic Surgery, 116 (1), 43-50. https://doi.org/10.1016/j.athoracsur.2022.10.021