title: Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection.
abstract: OBJECTIVE
  This study was undertaken to determine significant risk factors for proximal or distal reoperations after surgical correction of acute type A aortic dissection.
  
  
  METHODS
  Between 1980 and 2000, a total of 160 consecutive patients (mean age 57.5 +/- 13.3 years, 126 men) underwent surgery for acute type A aortic dissection. Proximal repair was performed by means of ascending aorta replacement with valve resuspension in 130 cases (81.3%), composite graft replacement in 19 cases (11.9%), separate aortic valve and ascending aorta replacement in 7 cases (4.4%), and aortic repair in 1 case (0.6%). Distal repair required arch replacement in 23 cases. Follow-up time averaged 4.51 +/- 5.6 years per patient.
  
  
  RESULTS
  Survival estimates after initial operation were 66.1% +/- 3.8%, 57.7% +/- 4.2%, 52.2% +/- 4.6%, and 42.5% +/- 5.8% at 1, 5, 10, and 15 years, respectively. Thirty patients required 37 reoperations at a mean interval of 5.7 +/- 4.5 years after the initial operation. Freedoms from reoperation were 96.9% +/- 1.8%, 74.7% +/- 5.3%, 60.8% +/- 6.8%, and 39.3% +/- 9.1% at 1, 5, 10, and 15 years, respectively. Reoperations included procedures on the proximal aorta (aortic root or valve) in 21 cases and on the distal aorta or its side branches in 19 cases. Cox regression analysis distinguished severe preoperative aortic valve insufficiency as the only significant risk factors for proximal reoperation; younger patient age, more distal extent of dissection, and more recent operative date were found to be significant risk factors for distal reoperation.
  
  
  CONCLUSIONS
  Patients with acute type A aortic dissection who have severe aortic valve insufficiency are at increased risk for proximal reoperation. These patients should benefit from a more aggressive proximal repair at initial operation. Distal extent of aortic resection at initial operation did not significantly influence the risk of distal reoperation.
authors.affiliation: Service de Chirurgie Thoracique et Cardiovasculaire, Hôpital Henri Mondor, Créteil, France. loisance@univ-paris12.fr
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Céline
authors.initials: C
authors.lastname: Soustelle
authors.forename: Rémi
authors.initials: R
authors.lastname: Houël
authors.forename: Marie Line
authors.initials: ML
authors.lastname: Hillion
authors.forename: Daniel
authors.initials: D
authors.lastname: Loisance
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors