Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis.
BACKGROUND
Aortic dissection is an evolving process that may require one or several reoperations after its initial repair. We conducted a study to evaluate risk factors and define the incidence and locations of reoperations after surgical correction of acute type A aortic dissection (AAD).


METHODS
Between 1998 and 2008, 250 consecutive patients (mean age 62.5±12.4 years) underwent surgery for AAD at our institution. Replacement of the ascending aorta was done in 173 cases, composite graft replacement in 61 cases, separate aortic valve and ascending aorta replacement in 2 cases, and arch replacement required by distal repair in 14 cases. Mean follow-up time was 4.7±5.6 years.


RESULTS
Freedom from reoperation was 99%, 82%, and 79% at 1, 5, and 10 years, respectively. Twenty-five patients required 25 reoperations at a mean interval of 4.7 years after initial surgery for the correction of AAD. Reoperations included 21 procedures on the proximal aorta (ascending aorta, aortic root, or valve) and 4 procedures on the distal aorta (arch or descending aorta). Cox regression analysis identified the use of gelatin-resorcinol-formaldehyde (GRF) glue (p=0.0270), and nonreplacement of the aortic root at the time of initial AAD repair (p=0.0004), as a significant risk factor for proximal reoperation, and a patent false lumen (p=0.0107) as a significant risk factor for distal reoperation.


CONCLUSIONS
A patent false lumen, the use of GRF glue, and aortic root preservation at initial operation influence the risk for surgical correction in patients undergoing surgery for AAD. These patients need long-term follow-up.
Department of Cardiac Surgery and Heart Transplantation, San Camillo Hospital, Rome, Italy. gioconci@libero.it
Giovanni
G
Concistrè
Giovanni
G
Casali
Eugenio
E
Santaniello
Andrea
A
Montalto
Brenno
B
Fiorani
Angelo
A
Dell'Aquila
Francesco
F
Musumeci
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D015897:Comorbidity; D018572:Disease-Free Survival; D004338:Drug Combinations; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde / Q000627:therapeutic use; D005780:Gelatin / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D012118:Resorcinols / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin