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Redo proximal thoracic aortic surgery: challenges and controversies

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  • Controversies in Surgery for Thoracic Aorta
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Abstract

Reoperations on the proximal thoracic aorta represent a challenge. The mortality rate is at least three times higher than it is for the initial surgery and the complications after such procedures occur with disappointingly high frequency, leading to substantial morbidity and delayed recovery. This article aims to present the early and the late outcomes of these kinds of operations, to identify the causes for failure of the primary surgery, to underline the critical points during the perioperative management of those patients and finally to emphasize on the rapid evolution and advent of techniques over the last few years.

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Abbreviations

AV:

Aortic valve

CVG:

Composite valve graft

AI:

Aortic insufficiency

LV:

Left ventricle

EF:

Ejection fraction

AVR:

Aortic valve replacement

HCA:

Hypothermic circulatory arrest

COR:

Class of recommendation

LOE:

Level of evidence

NYHA:

New York Heart Association

CPB:

Cardiopulmonary bypass

CT:

Computed tomography

MRI:

Magnetic resonance imaging

TEE:

Transesophageal echocardiogram

TTE:

Transthoracic echocardiogram

TEVAR:

Thoracic endovascular aortic repair

References

  1. Sioris T, David TE, Ivanov J, Armstrong S, Feindel CM. Clinical outcomes after separate and complete replacement of the aortic valve and the ascending aorta. J Thorac Cardiovasc Surg. 2004;128:260–5.

    Article  PubMed  Google Scholar 

  2. Zehr KJ, Orszulak TA, Mullany CJ, Matloobi A, Daly RC, Deerani JA, et al. Surgery for aneurysms of the aortic root. A 30-year experience. Circulation. 2004;110(11):1364–71.

    Article  PubMed  Google Scholar 

  3. Szeto WY, Bavaria JE, Bowen FW, Geirsson A, Cornelius K, Hargrove WC, Pochettino A. Reoperative aortic root replacement in patients with previous aortic surgery. Ann Thorac Surg 2007;84(5):1592–98 discussion 1598–9.

    Article  PubMed  Google Scholar 

  4. Di Eusanio M, Berretta P, Bissoni L, Petridis FD, Di Marco L, Di Bartolomeo R. Re-operations on the proximal thoracic aorta: results and predictors of short- and long-term mortality in a series of 174 patients. Eur J Cardiothorac Surg. 2011;40(5):1072–6. https://doi.org/10.1016/j.ejcts.2011.02.039.

    Article  PubMed  Google Scholar 

  5. Di Bartholomeo R, Berrettan P, Petridis FD, Folesani G, Cefarelli M, Di Marco L, Di Eusanio M. Reoperative surgery on the thoracic aorta. J Thorac Cardiovasc Surg 2013;145(3 Suppl):S78–84. https://doi.org/10.1016/j.jtcvs.2012.11.055.

    Article  Google Scholar 

  6. Schepens MA, Dossche KM, Morshuis WJ. Reoperations on the ascending aorta and aortic root: pitfalls and results in 134 patients. Ann Thorac Surg. 1999;68(5):1676–80.

    Article  CAS  PubMed  Google Scholar 

  7. Estera AL, Miller CC, Porat E, Mohamed S, Kincade R, Huynh TT, Safi HJ. Determinants of early and late outcome for reoperations on the proximal aorta. Ann Thorac Surg 2004;78(3):837–45; discussion 837–45.

    Google Scholar 

  8. Dougenis D, Daily BB, Kouchoukos NT. Reoperations on the aortic root and ascending aorta. Ann Thorac Surg 1997; 64(4):986–92.

    Article  CAS  PubMed  Google Scholar 

  9. Keeling WB, Leshnower BG, Thourani VH, Kilgo PS, Chen EP. Outcomes following redo sternotomy for aortic surgery. Interact Cardiovasc Thorac Surg. 2012;15(1):63–8. https://doi.org/10.1093/icvts/ivs127.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Silva J, Maroto LC, Carnero M, Vilacosta I, Cobiella J, et al. Ascending aorta and aortic root reoperations: are outcomes worse than first time surgery? Ann Thorac Surg. 2010;90(2):555–60. https://doi.org/10.1016/j.athoracsur.2010.03.092.

    Article  PubMed  Google Scholar 

  11. Dossche KM, Tan ME, Schepens MA, Morshuis WJ, de la Riviére AB. Twenty-four year experience with reoperations after ascending aortic or aortic replacement. Eur J Cardiothoracic Surg 1999;16 (6):607–12.

    Article  CAS  Google Scholar 

  12. David TE, Feindel CM, Ivanow J, Armstrong S. Aortic root replacement in patients with previous heart surgery. J Card Surg 2004;19(4):325–8.

    Article  PubMed  Google Scholar 

  13. Czerny M, Barchichat I, Meszaros K, Sodeck GH, Weber A, Reineke D, et al. Long-term results after proximal thoracic aortic redo surgery. PLoS One. 2013;8(3):e57713. https://doi.org/10.1371/journal.pone.0057713.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Chong BK, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. Reoperative aortic root replacement in patients with previous aortic root or aortic valve procedures. Korean J Thorac Cardiovasc Surg 2016;49(4):250–7. https://doi.org/10.5090/kjtcs.2016.49.4.250.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Malvindi PG, van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation after acute type A aortic dissection repair: a series of 104 patients. Ann Thorac Surg. 2013;95(3):922–7. https://doi.org/10.1016/j.athoracsur.2012.11.029.

    Article  PubMed  Google Scholar 

  16. Mookhoek A, de Kerchove L, El Khoury G, Weimar T, Luciani GB, Mazzucco A, et al. European multicentre experience with valve-sparing reoperations after the Ross procedure. J Thorac Cardiovasc Surg 2015;150 (5):1132–7. https://doi.org/10.1016/j.jtcvs.2015.08.043.

    Article  PubMed  Google Scholar 

  17. Pacini D, Di Marco L, Loforte A, Angeli E, Dell’amore A, Bargonzini M, Di Bartolomeo R. Reoperations on the ascending aorta and aortic root. Early and late results? J Cardiovasc Surg (Torino). 2005;46(5): 491–8.

    CAS  Google Scholar 

  18. Wang Z, Greason KL, Pochettino A, Schaff HV, Suri RM, Stulak JM, Dearani JA. Long-term outcomes of survival and freedom from reoperation on the aortic root or valve after surgery for acute ascending aorta dissection. J Thorac Cardiovasc Surg 2014;148(5):2117–22. https://doi.org/10.1016/j.jtcvs.2013.12.059.

    Article  PubMed  Google Scholar 

  19. De Bakey ME, Cooley SADA.. Successful resection of an aneurysm of thoracic aorta and replacement by graft. J Am Med Assoc 1953;152(8):673–6.

    Article  Google Scholar 

  20. Wheat MW Jr, Wilson JR, Bartley TD. Successful replacement of the entire ascending aorta and aortic valve. JAMA 1964;188:717–9.

    Article  PubMed  Google Scholar 

  21. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax 1968; 23(4):338–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Cabrol C, Pavie A, Gandjbakhch I, Villemot JP, Guiraudon G, Laughlin L, et al. Complete replacement of the ascending aorta with reimplantation of the coronary arteries: new surgical approach. J Thorac Cardiovac Surg. 1981;81(2):309–15.

    CAS  Google Scholar 

  23. Kouchoukos NT. Composite graft replacement of the ascending aorta and aortic valve with the inclusion-wrap and open techniques. Semin Thorac Cardiovasc Surg. 1991;3(3):171–6.

    CAS  PubMed  Google Scholar 

  24. Ross DN. Replacement of the aortic and mitral valves with a pulmonary autograft. Lancet 1967;2(7523): 956–8.

    Article  CAS  PubMed  Google Scholar 

  25. David TE, Feindel CM. An aortic valve—sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardioavasc Surg 1992;103(4):617–21; discussion 622.

    Google Scholar 

  26. Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg 1998; 115(5):1080–90.

    Article  CAS  PubMed  Google Scholar 

  27. Ergin MA, O’ Connor J, Guinto R, Griepp RB. Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections. J Thorac Cardiovasc Surg 1982;84(5):649–55.

    CAS  PubMed  Google Scholar 

  28. Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thor Surg 2002;74(5):S1877–80. discussion S1892–8.

    Article  Google Scholar 

  29. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. ACCF/AHA/AATS/ACR/ASA /SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and the management of patients with thoracic aortic disease. J Am Coll Cardiol 2010;55(14):e27–e129. https://doi.org/10.1016/j.jacc.2010.02.015.

    Article  Google Scholar 

  30. Stulak JM, Burkhart HM, Sundt TM 3rd, Connolly HM, Suri RM, Schaff HV, Dearani JA. Spectrum and outcome of reoperations after the Ross procedure. Circulation 2010;122(12):1153–8. https://doi.org/10.1161/CIRCULATIONAHA.109.897538.

    Article  PubMed  Google Scholar 

  31. David TE. Ross procedure at the crossroads. Circulation. 2009;119(2):207–9. https://doi.org/10.1161/CIRCULATIONAHA.108.827964.

    Article  PubMed  Google Scholar 

  32. Elkins RC, Thompson DM, Lane MM, Elkins CC, Peyton MD. Ross operation: 16-year experience. Thorac Cardiovasc Surg 2008;136(3):623–30, 630.e1-5. https://doi.org/10.1016/j.jtcvs.2008.02.080.

    Article  Google Scholar 

  33. David TE. Aortic valve sparing operations: outcomes at 20 years. Ann Cardiothorac Surg. 2013;2(1):24–9. https://doi.org/10.3978/j.iisn.2225-319X.2012.11.15.

    Article  PubMed  PubMed Central  Google Scholar 

  34. David TE, Feindel CM, Armstrong S, Maganti M. Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm. J Thorac Cariovasc Surg 2007 Feb; 133 (2): 414–8.

  35. Coselli JS, Crawford ES, Williams TW, Bradshaw MW, Wiemer DR, Harris RL, Safi HJ. Treatment of postoperative infection of ascending aorta and transverse aortic arch, including use of viable omentum and muscle flaps. Ann Thorac Surg. 1990;50(6):868–81.

    Article  CAS  PubMed  Google Scholar 

  36. Coselli JS, Köksoy C, LeMaire SA. Management of thoracic aortic graft infections. Ann Thorac Surg 1999; 67(6):1990–3;discussion 1997–8.

    Google Scholar 

  37. Leontyev S, Bonger MA, Davierwala P, Walther T, Lehmann S, Kempfert J, Mohr FW. Redo aortic valve surgery: early and late outcomes. Ann Thorac Surg 2011; 91(4):120–6. https://doi.org/10.1016/j.athoracsur.2010.12.053.

    Article  Google Scholar 

  38. Crawford SE, Crawford JL, Safi AJ, Coselli JS. Redo operations for recurrent aneurysmal disease of the ascending aorta and transverse aortic arch. Ann Thorac Surg 1985;40(5):439–55.

    Article  CAS  PubMed  Google Scholar 

  39. Williams JB, Peterson ED, Zhao Y, O’Brien SM, Andersen ND, Miller DC, et al. Contemporary results from proximal aortic replacement in North America. J Am Coll Cardiol 2012; 60(13):1156–62. https://doi.org/10.1016/j.jacc.2012.06.023.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bashir M, Shaw MA, Grayson AD, Fok M, Hickey GL, Grant SW, Bridgewater B, Oo AY. Development and validation of elective and non-elective risk prediction models for in-hospital mortality in proximal aortic surgery using the National Institute for Cardiovascular Outcomes Research (NICOR) Database. Ann Thorac Surg 2012;101(5):1670–6. https://doi.org/10.1016/j.athorascur.2015.10.067.

    Article  Google Scholar 

  41. Dobell AR, Jain AK. Catastrophic haemorrhage during redo sternotomy. Ann Thorac Surg 1984; 37(4):273–8.

    Article  CAS  PubMed  Google Scholar 

  42. Luciani N, Anselmi A, de Geest R, Martinelli L, Perisano M, Possati G. Extracorporeal circulation by peripheral cannulation before sternotomy: indications and results. J Thorac Cardiovasc Surg 2008;136 (3):572–7. https://doi.org/10.1016/j.jctvs.2008.02.071.

    Article  PubMed  Google Scholar 

  43. Benedetto U, Raja SG, Amrani M, Pepper JR, Zeinah M, Tonelli E, et al. The impact of arterial cannulation on operative outcomes in aortic surgery: evidence from a comprehensive meta- analysis of comparative studies on 4476 patients. J Thorac Cardiovasc Surg 2014; 148(6):2963–43. https://doi.org/10.1016/j.jtcvs.2014.05.082.

    Article  Google Scholar 

  44. Luciani N, De Geest R, Anselmi A, Glieca F, De Paulis S, Possati G. Results of reoperation on the aortic root and the ascending aorta. Ann Thorac Surg 2011; 92(3):898–903. https://doi.org/10.1016/j.athorascur.2011.04.116.

    Article  PubMed  Google Scholar 

  45. Spadaccio C, Rainer A, Barbato R, Chello M, Meyns B. The fate of large-diameter Dacron vascular grafts in surgical practise: are we really satisfied? Int J Cardiol. 2013;168(5):5028–9. https://doi.org/10.1016/j.ijcard.2013.07.165.

    Article  PubMed  Google Scholar 

  46. Takami Y, Tajima K, Kato W, Fujii K, Hibino M, Munakata H, et al. Long-term size follow-up of knitted Dacron grafts (Gelseal ™) used in the ascending aorta. Interact Cardiovasc Thorac Surg. 2012;14(5):529–31. https://doi.org/10.1093/icvts/ivr086.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Moreno MJ, Ajji A, Mohebbi-Kalhori D, Rukhlova M, Hadjizadeh A, Bereau MN. Development of a compliant and cytocompatible micro-fibrous polyethylene terephthalate vascular scaffold. J Biomed Mater Res B Appl Biomater 2011; 97(2):201–14. https://doi.org/10.1002/jbm.B.31774.

    Article  CAS  PubMed  Google Scholar 

  48. Watanabe Y, Shimamura K, Shirakawa Y, Torikai K, Kuratani T, Sawa Y. A new staged hybrid total arch repair procedure using a branched proximal elephant trunk technique with implantation of stent grafts to the ascending aorta. J Vasc Surg 2013; 58(6):1700–4. https://doi.org/10.1016/j.jvs.2013.05.044.

    Article  PubMed  Google Scholar 

  49. Dorros G, Dorros AM, Planton S, O’Hair D, Zayed M. Transeptal guidewire stabilization facilitates stent-graft deployment for persistent proximal ascending aortic dissection. J Endovasc Ther. 2000;7(6):506–12.

    Article  CAS  PubMed  Google Scholar 

  50. Mestres G, Yugueros X, Brinster C, et al. Endovascular techniques for treating ascending aortic pathology. Endovasc Today. 2014;13:60–6.

    Google Scholar 

  51. Roselli EE, Idrees J, Greenberg RK, Johnston DR, Lytle BW. Endovascular stent grafting for ascending aorta repair in high-risk patients. J Thorac Cardiovasc Surg 2015; 149(1):144–54. https://doi.org/10.1016/j.jtcvs.2014.07.109.

    Article  PubMed  Google Scholar 

  52. Cao P, De Rango P, Czerny M, Evangelista A, Fattori R, Niembar C, Rousseau H, Schepens M. Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases. J Thorac Cardiovasc Surg 2012;144(6):1286–300. https://doi.org/10.1016/j.jtcvs.2012.06.013.

    Article  Google Scholar 

  53. Kuratani T. Best surgical option for arch extension of Type B dissection: the endovascular approach. Ann Cardiothorac Surg. 2014 May;3(3):292–9. https://doi.org/10.3978/j.issn.2225-319X.2014.04.04.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Halstead JC, Meier M, Etz C, Spielvogel D, Bodian C, Wurm M, et al. The fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007;133(1):127–35.

    Article  PubMed  Google Scholar 

  55. Strauch JT, Spielvogel D, Lansman SL, Lauten AL, Bodian C, Griepp RB. Long term integrity of Teflon felt-supported suture lines in aortic surgery. Ann Thorac Surg. 2005;79(3):796–800.

    Article  PubMed  Google Scholar 

  56. Iribarne A, Keenan J, Benrashid E, Wang H, Meza JM, Ganapathi A, et al. Imaging surveillance after proximal aortic operations: is it necessary? Ann Thorac Surg. 2017;103(3):734–41. https://doi.org/10.1016/j.athoracsur.2016.06.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE, UK

    Athanasios Antoniou, Mohamad Bashir, Amer Harky & Carmelo Di Salvo

  2. Cardiothoracic Surgery, Northwest deanery, Merseyside, UK

    Amer Harky

  3. School of Medicine, Cardiff University, Cardiff, UK

    Amer Harky

Authors
  1. Athanasios Antoniou
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  2. Mohamad Bashir
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  3. Amer Harky
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  4. Carmelo Di Salvo
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Correspondence to Mohamad Bashir.

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Antoniou, A., Bashir, M., Harky, A. et al. Redo proximal thoracic aortic surgery: challenges and controversies. Gen Thorac Cardiovasc Surg 67, 118–126 (2019). https://doi.org/10.1007/s11748-018-0941-y

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  • DOI: https://doi.org/10.1007/s11748-018-0941-y

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