OBJECTIVE: Late complications can develop in patients after surgery for aortic type A dissection, mandating redo surgery on the ascending aorta and arch. METHODS: From 2006 to 2010, 23 patients (aged 41-69 years) who had late complications related to previous aortic surgery for acute type A dissection underwent redo surgery. Initial surgery included ascending aorta replacement in all cases. RESULTS: The main indications for reoperation were progressive enlargement of the false lumen of the aortic arch or descending aorta and suture line dehiscence in 10 patients each. All patients with progressive aneurysm formation in nonresected aortic segments had persistent dissection within the aortic arch since initial surgery. Suture line dehiscence led to a localized hematoma in most cases. Three patients presented with graft infection and extensive perigraft hematoma. The average time interval from the initial repair to the redo procedure was 71±56 months. Exchange of the formerly implanted Dacron graft in the ascending aorta was the most frequently used surgical procedure. Implantation of a valved conduit was deemed necessary in 4 cases, and isolated aortic valve replacement was necessary in 2 cases. A hybrid stent graft was used in 6 patients. All patients survived surgery, and 1 patient died of postoperative low output cardiac failure in hospital. Only 1 major stroke was noted. CONCLUSIONS: Complex reoperations for repaired acute type A dissection can be performed safely. The concern for the reoperative risk should not dictate the operative strategy during the initial procedure in acute type A dissection.
OBJECTIVE: Late complications can develop in patients after surgery for aortic type A dissection, mandating redo surgery on the ascending aorta and arch. METHODS: From 2006 to 2010, 23 patients (aged 41-69 years) who had late complications related to previous aortic surgery for acute type A dissection underwent redo surgery. Initial surgery included ascending aorta replacement in all cases. RESULTS: The main indications for reoperation were progressive enlargement of the false lumen of the aortic arch or descending aorta and suture line dehiscence in 10 patients each. All patients with progressive aneurysm formation in nonresected aortic segments had persistent dissection within the aortic arch since initial surgery. Suture line dehiscence led to a localized hematoma in most cases. Three patients presented with graft infection and extensive perigraft hematoma. The average time interval from the initial repair to the redo procedure was 71±56 months. Exchange of the formerly implanted Dacron graft in the ascending aorta was the most frequently used surgical procedure. Implantation of a valved conduit was deemed necessary in 4 cases, and isolated aortic valve replacement was necessary in 2 cases. A hybrid stent graft was used in 6 patients. All patients survived surgery, and 1 patient died of postoperative low output cardiac failure in hospital. Only 1 major stroke was noted. CONCLUSIONS: Complex reoperations for repaired acute type A dissection can be performed safely. The concern for the reoperative risk should not dictate the operative strategy during the initial procedure in acute type A dissection.
Authors: Angelo M Dell'Aquila; Francesco Pollari; Khalil Fattouch; Giuseppe Santarpino; Julia Hillebrand; Stefan Schneider; Jan Landwerht; Giuseppe Nasso; Renato Gregorini; Mauro Del Giglio; Elisa Mikus; Alberto Albertini; Heinz Deschka; Theodor Fischlein; Sven Martens; Alina Gallo; Giovanni Concistrè; Giuseppe Speziale; Tommaso Regesta Journal: Heart Vessels Date: 2016-10-21 Impact factor: 2.037
Authors: Robert B Hawkins; J Hunter Mehaffey; Emily A Downs; Lily E Johnston; Leora T Yarboro; Clifford E Fonner; Alan M Speir; Jeffrey B Rich; Mohammed A Quader; Gorav Ailawadi; Ravi K Ghanta Journal: Ann Thorac Surg Date: 2017-06-06 Impact factor: 4.330
Authors: Martin Czerny; Maximilian Kreibich; Julia Morlock; Stoyan Kondov; Johannes Scheumann; Holger Schröfel; Fabian A Kari; Tim Berger; Matthias Siepe; Friedhelm Beyersdorf; Bartosz Rylski Journal: J Vis Surg Date: 2018-01-17