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Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database

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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.

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Abbreviations

AAD:

Acute type A aortic dissection

AVR:

Aortic valve replacement

BMI:

Body mass index

BSA:

Body surface area

CABG:

Coronary artery bypass grafting

COPD:

Chronic obstructive pulmonary disease

EF:

Ejection fraction

FET:

Frozen elephant trunk

ET:

Elephant trunk

ICU:

Intensive care unit

LOS:

Length of stay

MOF:

Multiorgan failure

REAAD:

Re-do operation after acute type A aortic dissection

TEVAR:

Thoracic endovascular aortic repair

VAD:

Ventricular assist device

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    Authors and Affiliations

    1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital of the Westfaelische Wilhelms–University Muenster, Albert-Schweitzer-Campus 1, 48159, Muenster, Germany

      Angelo M. Dell’Aquila, Julia Hillebrand, Stefan Schneider, Jan Landwerht, Heinz Deschka & Sven Martens

    2. Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany

      Francesco Pollari, Giuseppe Santarpino & Theodor Fischlein

    3. Department of Cardiovascular Surgery, Maria Eleonora Hospital GVM Care and Research, Palermo, Italy

      Khalil Fattouch

    4. Department of Cardiovascular Surgery, Anthea Hospital GVM Care and Research, Bari, Italy

      Giuseppe Nasso & Giuseppe Speziale

    5. Department of Cardiovascular Surgery, Cardiac Surgery Unit, Città di Lecce Hospital GVM Care and Research, Lecce, Italy

      Renato Gregorini

    6. Department of Cardiovascular Surgery, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy

      Mauro del Giglio, Elisa Mikus & Alberto Albertini

    7. Department of Cardiac Surgery, San Martino University Hospital, University of Genova, Genoa, Italy

      Alina Gallo & Tommaso Regesta

    8. Fondazione CNR Ospedale del cuore “G. Pasquinucci”, Massa, Italy

      Giovanni Concistrè

    Authors
    1. Angelo M. Dell’Aquila
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    2. Francesco Pollari
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    3. Khalil Fattouch
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    4. Giuseppe Santarpino
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    5. Julia Hillebrand
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    6. Stefan Schneider
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    9. Renato Gregorini
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    Corresponding author

    Correspondence to Julia Hillebrand.

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    No author has a conflict of interest related to the material reported in this study.

    Additional information

    A. M. Dell’Aquila and F. Pollari contributed equally to this work and should both be considered as first authors.

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    Dell’Aquila, A.M., Pollari, F., Fattouch, K. et al. Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database. Heart Vessels 32, 566–573 (2017). https://doi.org/10.1007/s00380-016-0907-x

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