Redo cardiac surgery after type A dissection repair- early and long term results

Background

Acute type A aortic dissection is a severe condition with mortality rate of up to 50% in the absence of surgical intervention. According to the literature 8.7% - 13.5% of patients require reoperation following the postoperative period. Most studies in the literature focus on short-term complications and 30-day or in-hospital mortality following surgical repair. Studies on long-term outcomes are more uncommon.

Objectives

The aim of the study is to evaluate early and late outcomes of reoperations after type A dissection repair.

Methods

Between January 2004 and June 2018, 171 patients underwent surgical repair of acute type A Aortic dissection, 15 patients (mean age 62±10 years, male 80%) underwent late reoperation during the follow up period. We evaluated retrospectively the early and late outcomes.

Results

In this very high risk population (Log.Euroscore 18.5 ±13.9, LVEF 56±9%), Indication for reoperation was psudoaneurism 46.6%, aortic insufficiency 33.3%, endocarditis 13.3% and recurrent distal dissection 6.6%. Cardiopulmonary bypass time, hospital stay and ICU stay (160±59min, 15±11d, 5±4d, respectively) with 13% major complications (1 patients with low cardiac output and 1 patient with dialysis). There was no intraoperative mortality, in hospital mortality was 13% 2 (patients). Mean follow up duration was 38±41d. There was 13% major complications (2 patients with arrhythmia), there was no cerebrovascular events, Myocardial infarction or bleeding. Late mortality from all cause was 3 patients.

Conclusion

Despite surgical challenges and high risk patients, early and late outcomes of reoperation after type A dissection repair are acceptable.