title: Late reoperations after acute aortic dissection repair: Single-center experience.
abstract: BACKGROUND
  After repair of acute type A aortic dissection, aortic complications can develop, and reoperations might be necessary. In our retrospective study, we wanted to assess early and late outcomes in this cohort of patients.
  
  
  METHODS
  From September 2005 to July 2012, 21 consecutive patients previously operated on for acute type A aortic dissection underwent 27 redo aortic surgical procedures. Indications for redo procedures were: enlargement of the false lumen in the residual aorta (18 events), severe aortic regurgitation with or without aortic root dilatation (8 events), suture dehiscence and pseudoaneurysm at the proximal or distal aortic graft anastomosis (5 events) or at the coronary button anastomosis in patients who previously underwent a Bentall procedure (1 patient). In all cases, total or partial cardiopulmonary bypass was used. Hypothermic cardiocirculatory arrest was needed in 22 (81%) procedures.
  
  
  RESULTS
  Hospital mortality was 3.7% (1/27), reexploration for bleeding and paraplegia rates were 7.4% and 7.4%, respectively. Marfan patients received 3.2 procedures per patient vs. 1.5 in non-Marfan patients (p < 0.01). At a mean follow-up of 6.5 years, 2 aortic events occurred: 1 aortic death, and 1 additional aortic redo surgery.
  
  
  CONCLUSIONS
  When procedures are carried out on elective basis, redo aortic surgery can be performed in all segments of the aorta with good early and late outcomes. Close lifelong clinical and radiological follow-up is mandatory. After repair of acute type A aortic dissection, Marfan patients are more prone to develop late complications, with a more rapid evolution.
authors.affiliation: Cardiac Surgery, Catholic University, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Luciani
authors.affiliation: Thoracic and Cardiovascular Surgery, Onze Lieve Vrouw Clinic, Aalst, Belgium.
authors.forename: Raphael
authors.initials: R
authors.lastname: De Geest
authors.affiliation: Cardiac Surgery, Catholic University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lauria
authors.affiliation: Cardiac Surgery, Catholic University, Rome, Italy piero.farina@yahoo.it.
authors.forename: Piero
authors.initials: P
authors.lastname: Farina
authors.affiliation: Cardiac Surgery, Catholic University, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Luciani
authors.affiliation: Cardiac Surgery, Catholic University, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Glieca
authors.affiliation: Cardiac Surgery, Catholic University, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Aneurysm; Aortic aneurysm; Blood vessel prosthesis implantation; Disease progression; Marfan syndrome; Reoperation; dissecting; thoracic