Outcomes of reoperation after acute type a aortic dissection: Implications for index repair strategy

Background--the optimal surgical approach for management of acute type a aortic dissection remains controversial. this study aimed to assess outcomes of reoperation after acute type a dissection repair to help guide decision making around index operative strategy. methods and results--all aortic reoperations (n=129) at a single referral institution from august 2005 to april 2016 after prior acute type a dissection repair were reviewed. the primary outcome was 30-day or in-hospital mortality. secondary outcomes included organ-specific morbidity and 1-and 5-year outcomes as estimated using the kaplan-meier method. the majority of initial reoperations were proximal aortic (aortic valve,aortic root,or ascending) or aortic arch procedures (62.5%,n=55); most initial reoperations were performed in the elective setting (83.1%,n=74). additional nonstaged second or more reoperations were required in 21 patients (23.6%) after the initial reoperation,during a median follow-up of 2.5 years after the initial reoperation. thirty-day or in-hospital mortality for all reoperations was 7.0% (elective: 6.3%; nonelective: 11.1%) with acceptable rates of organspecific morbidity,given the procedural complexity. one- and 5-year overall survival after initial reoperation was 85.9% and 64.9%,respectively,with aorta-specific survival of 88% at 5 years. conclusions--reoperation after acute type a aortic dissection repair is associated with low rates of mortality and morbidity. these data support more limited index repair for acute type a dissection,especially for patients undergoing index repair in lower volume centers without expertise in extensive repair,because reoperations,if needed,can be performed safely in referral aortic centers. © 2017 the authors.