Proximal Reoperations After Repaired Acute Type A Aortic Dissection
| Autor: | Anthony L. Estrera, Ali Azizzadeh, Riad Meada, Sheila M. Coogan, Taek Yeon Lee, Martin A. Villa, Hazim J. Safi, Charles C. Miller, Adel D. Irani |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine Thorax medicine.medical_specialty Adolescent Elephant trunks Blood Vessel Prosthesis Implantation Aortic valve replacement Internal medicine medicine.artery Humans Medicine Aged Retrospective Studies Aortic dissection Aorta business.industry Respiratory disease Middle Aged medicine.disease Aortic Aneurysm Surgery Aortic Dissection Treatment Outcome medicine.anatomical_structure Respiratory failure Cardiology Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | The Annals of Thoracic Surgery. 83:1603-1609 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2007.01.029 |
| Popis: | Concerned with the associated risks of proximal reoperation, some have proposed an aggressive approach of aortic root replacement during emergent repair of acute type A aortic dissection. Because few data exist regarding late reoperations, we report outcomes of proximal reoperation after repaired type A aortic dissection.Between January 1991 and March 2006, 63 patients underwent reoperation after previous repair for acute type A aortic dissection. Procedures performed at reoperation included ascending (94%, 59 of 63), total arch (62%, 39 of 63), elephant trunk (56%, 35 of 63), aortic valve replacement (38%, 24 of 63), aortic root (27%, 17 of 63), and coronary artery bypass graft (8%, 5 of 63). Preoperative, operative, and postoperative variables were analyzed retrospectively with regard to early and late mortality.Thirty-day mortality was 11.1% (7 of 63). No strokes occurred. Incidence of renal failure, respiratory failure, and bleeding was 6% (4 of 63), 23% (15 of 63), and 6% (4 of 63), respectively. Mean time from initial repair to reoperation was 69 months (range, 1 to 258). Procedure performed (root versus ascending/resuspension) at initial repair did not affect the time to reoperation (p0.05). Median follow-up was 40 months; and 1-, 5-, and 10-year survival was 82%, 74%, and 62%, respectively. Multivariate predictors of late mortality were prior coronary artery bypass graft surgery (odds ratio = 6.5, p0.003), bypass time (odds ratio = 3.6, p0.02), and renal dysfunction (odds ratio = 3.7, p0.05).Proximal reoperations for repaired acute type A aortic dissection can be performed with acceptable early and late mortality. The concern for proximal reoperation should not dictate the initial procedure choice during acute type A aortic dissection. Continued clinical and radiographic surveillance of repaired type A aortic dissection is warranted. |
| Databáze: | OpenAIRE |
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