title: Safe Reentry for False Aneurysm Operations in High-Risk Patients.
abstract: BACKGROUND
  In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients.
  
  
  METHODS
  We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery.
  
  
  RESULTS
  We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years.
  
  
  CONCLUSIONS
  The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery.
authors.affiliation: Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy. Electronic address: martinelligluca@gmail.com.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Martinelli
authors.affiliation: Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Cotroneo
authors.affiliation: Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Philippe Primo
authors.initials: PP
authors.lastname: Caimmi
authors.affiliation: Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Musica
authors.affiliation: Vascular Surgery Department, Ospedali Riuniti Bianchi Melacrino Morelli, Reggio Calabria.
authors.forename: David
authors.initials: D
authors.lastname: Barillà
authors.affiliation: Department of Cardiac Anesthesiology, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Edmond
authors.initials: E
authors.lastname: Stelian
authors.affiliation: Department of Cardiac Anesthesiology, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Romano
authors.affiliation: Department of Biostatistics and Clinical Research, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Novelli
authors.affiliation: Unit of Cardiopulmonary Circulatory Support, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Renzi
authors.affiliation: Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Diena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed