title: Proximal reoperations after repaired acute type A aortic dissection.
abstract: BACKGROUND
  Concerned with the associated risks of proximal reoperation, some have proposed an aggressive approach of aortic root replacement during emergent repair of acute type A aortic dissection. Because few data exist regarding late reoperations, we report outcomes of proximal reoperation after repaired type A aortic dissection.
  
  
  METHODS
  Between January 1991 and March 2006, 63 patients underwent reoperation after previous repair for acute type A aortic dissection. Procedures performed at reoperation included ascending (94%, 59 of 63), total arch (62%, 39 of 63), elephant trunk (56%, 35 of 63), aortic valve replacement (38%, 24 of 63), aortic root (27%, 17 of 63), and coronary artery bypass graft (8%, 5 of 63). Preoperative, operative, and postoperative variables were analyzed retrospectively with regard to early and late mortality.
  
  
  RESULTS
  Thirty-day mortality was 11.1% (7 of 63). No strokes occurred. Incidence of renal failure, respiratory failure, and bleeding was 6% (4 of 63), 23% (15 of 63), and 6% (4 of 63), respectively. Mean time from initial repair to reoperation was 69 months (range, 1 to 258). Procedure performed (root versus ascending/resuspension) at initial repair did not affect the time to reoperation (p > 0.05). Median follow-up was 40 months; and 1-, 5-, and 10-year survival was 82%, 74%, and 62%, respectively. Multivariate predictors of late mortality were prior coronary artery bypass graft surgery (odds ratio = 6.5, p < 0.003), bypass time (odds ratio = 3.6, p < 0.02), and renal dysfunction (odds ratio = 3.7, p < 0.05).
  
  
  CONCLUSIONS
  Proximal reoperations for repaired acute type A aortic dissection can be performed with acceptable early and late mortality. The concern for proximal reoperation should not dictate the initial procedure choice during acute type A aortic dissection. Continued clinical and radiographic surveillance of repaired type A aortic dissection is warranted.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas-Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Texas 77030, USA. anthony.l.estrera@uth.tmc.edu
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.forename: Martin A
authors.initials: MA
authors.lastname: Villa
authors.forename: Taek-Yeon
authors.initials: TY
authors.lastname: Lee
authors.forename: Riad
authors.initials: R
authors.lastname: Meada
authors.forename: Adel
authors.initials: A
authors.lastname: Irani
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
authors.forename: Sheila
authors.initials: S
authors.lastname: Coogan
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome