title: Outcomes of aortic arch replacement surgery after previous cardiac surgery.
abstract: BACKGROUND
  Aortic arch replacement is a potentially high-risk operation and in the re-operative setting has been found to be a risk factor for poor outcome, yet there is a dearth of published data specifically on this topic. The aim of the study was to review our unit's outcomes in this re-operative setting.
  
  
  METHODS
  Data were collated for all patients who underwent aortic arch replacement surgery after previous cardiac surgery from January 1988 to November 2011. The patients were divided based primarily on elective versus non-elective and also early (≤2005) and late (≥2006) series.
  
  
  RESULTS
  Twenty-seven eligible patients (22 male; median age: 53.0 years; elective: 14, non-elective: 13) were identified. There was a mean period of 14.5 years between the first operation and the subsequent aortic arch replacement. The overall 30-day mortality rate was 22.2% - 0% elective and 46.2% non-elective (P = 0.004). Overall permanent neurological dysfunction was 21.7% - 28.6% elective and 11.1% non-elective (P = 0.463). There were 11 early-series patients and 16 late-series patients. For early-series patients, 90.9% were non-elective versus 18.8% in the late-series patients. The 30-day mortality rate was 54.5% early series versus 0% late series.
  
  
  CONCLUSIONS
  Aortic arch replacement is high risk in the re-operative setting. These risks are even greater for non-elective procedures. This highlights the need for aggressive first-time surgery to reduce re-operative procedures and good long-term follow-up programmes to allow elective procedures if required.
authors.affiliation: Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; The Baird Institute for Heart and Lung Surgical Research, Sydney, New South Wales, Australia.
authors.forename: Reece A
authors.initials: RA
authors.lastname: Davies
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Bayfield
authors.forename: P Nicholas
authors.initials: PN
authors.lastname: Hendel
authors.forename: Clifford F
authors.initials: CF
authors.lastname: Hughes
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D006348:Cardiac Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: aortic arch; aortic dissection; aortic operation; hypothermia/circulatory arrest; reoperation (aortic arch)