Reoperative repair of the aortic root and the aortic arch following previous surgery for acute type A aortic dissection

Aim. Reoperations on the thoracic aorta are associated with acceptable operative mortality when performed electively. The purpose of this study was to evaluate the strategy and operative outcome in patients who underwent reoperation on the aortic root and the aortic arch and investigate the patterns of failure necessitating reoperation following surgical repair of acute type A dissection. Methods. Nine patients who had previously undergone surgical repair of acute type A aortic dissection were reoperated between 2001 and 2008. The most common previous procedure was "aortoplasty" with concurrent replacement of the aortic valve. Early and mid-term outcome was retrospectively analyzed. Results. Seven patients underwent aortic root replacement with composite valved graft (one with hemi-arch replacement), and two had replacement of the ascending aorta and the entire aortic arch. There was one in-hospital death. Three patients required reexplorations for bleeding and two required prolonged mechanical ventilation. Conclusion. Surgical treatment of acute type A aortic dissection with techniques employing avoidance of graft replacement of the ascending aorta or the aortic root carries a high risk of reoperation. An effort should be made to address all possible pathology in the ascending aorta, the aortic root and the proximal aortic arch at the initial operation to decrease the incidence of future reoperation.