title: Aortic dissection after previous cardiovascular surgery.
abstract: BACKGROUND
  Risk of repairing aortic dissection after previous cardiovascular surgery has not been described clearly. This study assesses early and late outcomes of such reoperations.
  
  
  METHODS
  From January 1, 1990, to January 1, 2002, 108 patients with prior cardiovascular surgery (isolated coronary artery bypass grafting, 51%; isolated valve surgery, 21%; aortic aneurysm repair, 24%; and combinations of these in the remainder) underwent reoperation for aortic dissection (emergency operation for acute dissection in 24%). Mean age was 63 +/- 13 years, and 85% were men. The interval since prior surgery ranged from 10 days to 22 years (median, 3.8 years). This was the third operation for 8%. Ascending aortic repair with or without aortic arch or descending aortic repair was performed in 40%, aortic valve replacement (n = 15) or repair (n = 17) with ascending aortic repair in 30%, aortic root replacement with or without aortic arch or descending aortic repair in 30%, and aortic arch with or without descending aortic repair in 1%. Circulatory arrest was used in 78%, with retrograde brain perfusion in 58%.
  
  
  RESULTS
  Hospital mortality was 6%, stroke 4%, renal failure 2%, and respiratory failure 7%. Survival at 30 days and 1, 3, 5, and 7 years was 93%, 85%, 74%, 63%, and 53%, respectively. Aortic reoperation was performed in 7 patients, with freedom from this event at 30 days and 1, 3, 5, and 7 years of 98%, 95%, 93%, 91%, and 89%., respectively
  
  
  CONCLUSIONS
  Aortic dissection after cardiovascular surgery is rare and can be managed with acceptable operative risks and good long-term survival. Need for subsequent aortic reoperation is uncommon.
authors.affiliation: Center for Aortic Surgery and Marfan and Connective Tissue Disorder Clinic and Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirose
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.forename: Delos M
authors.initials: DM
authors.lastname: Cosgrove
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000209:etiology; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome