title: Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database.
abstract: This study provides early results of re-operations after the prior surgical treatment of acute type A aortic dissection (AAD) and identifies risk factors for mortality. Between May 2003 and January 2014, 117 aortic re-operations after an initial operation for AAD (a mean time from the first procedure was 3.98 years, with a range of 0.1-20.87 years) were performed in 110 patients (a mean age of 59.8 ± 12.6 years) in seven European institutions. The re-operation was indicated due to a proximal aortic pathology in ninety cases: twenty aortic root aneurysms, seventeen root re-dissections, twenty-seven aortic valve insufficiencies and twenty-six proximal anastomotic pseudoaneurysms. In fifty-eight cases, repetitive surgical treatment was subscripted because of distal aortic pathology: eighteen arch re-dissections, fifteen arch dilation and twenty-five anastomotic pseudoaneurysms. Surgical procedures comprised a total of seventy-one isolated proximals, thirty-one isolated distals and fifteen combined interventions. In-hospital mortality was 19.6 % (twenty-three patients); 11.1 % in patients with elective/urgent indication and 66.6 % in emergency cases. Mortality rates for isolated proximal, distal and combined operations regardless of the emergency setting were 14.1 % (10 pts.), 25.8 % (8 pts.) and 33.3 % (5 pts.), respectively. The causes of death were cardiac in eight, neurological in three, MOF in five, sepsis in two, bleeding in three and lung failure in two patients. A multivariate logistic regression analysis revealed that risk factors for mortality included previous distal procedure (p = 0.04), new distal procedure (p = 0.018) and emergency operation (p < 0.001). New proximal procedures were not found to be risk factors for early mortality (p = 0.15). This multicenter experience shows that the outcome of REAAD is highly dependent on the localization and extension of aortic pathology and the need for emergency treatment. Surgery in an emergency setting and distal re-do operations after previous AAD remain a surgical challenge, while proximal aortic re-operations show a lower mortality rate. Foresighted decision-making is needed in cases of AAD repair, as the results are essential preconditions for further surgical interventions.
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, 48159, Muenster, Germany.
authors: Angelo M
authors: AM
authors: Dell'Aquila
authors: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany.
authors: Francesco
authors: F
authors: Pollari
authors: Department of Cardiovascular Surgery, Maria Eleonora Hospital GVM Care and Research, Palermo, Italy.
authors: Khalil
authors: K
authors: Fattouch
authors: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany.
authors: Giuseppe
authors: G
authors: Santarpino
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, 48159, Muenster, Germany. juliahillebrand@yahoo.de.
authors: Julia
authors: J
authors: Hillebrand
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, 48159, Muenster, Germany.
authors: Stefan
authors: S
authors: Schneider
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, 48159, Muenster, Germany.
authors: Jan
authors: J
authors: Landwerht
authors: Department of Cardiovascular Surgery, Anthea Hospital GVM Care and Research, Bari, Italy.
authors: Giuseppe
authors: G
authors: Nasso
authors: Department of Cardiovascular Surgery, Cardiac Surgery Unit, Città di Lecce Hospital GVM Care and Research, Lecce, Italy.
authors: Renato
authors: R
authors: Gregorini
authors: Department of Cardiovascular Surgery, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy.
authors: Mauro
authors: M
authors: Del Giglio
authors: Department of Cardiovascular Surgery, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy.
authors: Elisa
authors: E
authors: Mikus
authors: Department of Cardiovascular Surgery, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy.
authors: Alberto
authors: A
authors: Albertini
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, 48159, Muenster, Germany.
authors: Heinz
authors: H
authors: Deschka
authors: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany.
authors: Theodor
authors: T
authors: Fischlein
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, 48159, Muenster, Germany.
authors: Sven
authors: S
authors: Martens
authors: Department of Cardiac Surgery, San Martino University Hospital, University of Genova, Genoa, Italy.
authors: Alina
authors: A
authors: Gallo
authors: Fondazione CNR Ospedale del cuore "G. Pasquinucci", Massa, Italy.
authors: Giovanni
authors: G
authors: Concistrè
authors: Department of Cardiovascular Surgery, Anthea Hospital GVM Care and Research, Bari, Italy.
authors: Giuseppe
authors: G
authors: Speziale
authors: Department of Cardiac Surgery, San Martino University Hospital, University of Genova, Genoa, Italy.
authors: Tommaso
authors: T
authors: Regesta
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Aortic valve replacement; Ascending aorta replacement; Reoperation