title: Ascending aorta or arch surgery: is previous cardiac surgery a risk factor?
abstract: Surgery on the ascending aorta +/- arch is a challenge. The risks involved in such operations after previous cardiac surgery were assessed in elective and emergency settings in a single institution. Over a 10-year period, 29 patients underwent replacement of the ascending aorta +/- arch following previous cardiac surgery. In 12 patients (41.4%), the procedure was carried out on an emergency basis. Thirteen had previous replacement of the ascending aorta and 16 had previous valve replacement with or without coronary artery bypass; 4 patients were undergoing a 3rd cardiac operation. Concomitant procedures included coronary artery bypass in 2, arch replacement in 4, and descending aortic replacement in one. The overall in-hospital mortality was 13.8% (4/29) vs. 12.4% (33/267) in primary procedures. Mortality in elective repeat surgery was 5.9% (1/17) vs. 25% (3/12) in emergency re-operations. The incidences of permanent stroke (3.4%) and renal failure (3.4%) were similar to first-time operations. Elective re-operation for ascending aorta +/- arch repair can be accomplished with acceptable mortality and morbidity. Outcomes in emergency cases carry a higher early mortality but still conform to contemporary expectations and are similar to emergency first-time aortic surgery.
authors.affiliation: Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Narayan
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bryan
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000401:mortality; D017558:Elective Surgical Procedures / Q000379:methods / Q000401:mortality; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology