title: Late reoperations after repaired acute type A aortic dissection.
abstract: 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.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kobuch
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.forename: Stephan
authors.initials: S
authors.lastname: Hirt
authors.forename: Andreas
authors.initials: A
authors.lastname: Keyser
authors.forename: Thomas
authors.initials: T
authors.lastname: Puehler
authors.forename: Matthias
authors.initials: M
authors.lastname: Amman
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zink
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013997:Time Factors