An Analysis of Total Arch Re-Replacement After Proximal Aortic Surgery
DOI:
https://doi.org/10.1532/hsf.4663Keywords:
Acute aortic dissection, aneurysm, total arch replacement, reoperationAbstract
Background: After proximal aortic surgery, total arch replacement (TAR) may again be needed because of recurrent dissection or aneurysm. This paper analyzed the relevant data of this technology with hopes of improving cognition and treatment.
Methods: There were a total of 60 eligible cases of secondary TAR after proximal aortic surgery in our center from 2010 to 2020. The primary surgical procedures included aortic valve replacement (AVR), ascending aortic replacement, Bentall, hemi-arch replacement, and thoracic endovascular aortic repair (TEVAR). The data were analyzed using the IBM SPSS Statistics 23.0 for Windows™ and presented as the mean ± standard deviations and direct frequencies, as appropriate.
Results: The interval between two operations was 44.8±53.6 months, 24 cases (40%) underwent emergency operation, the recurrence of type A dissection included 51 cases, accounting for 85% of the causes of total arch re-replacement. In the second surgical procedures, the ascending + TAR + stented elephant trunk (SET) implantation accounted for 75.0%. The overall surgical success rate was 98.3%. Postoperative respiratory complications were the most common, including infection, pneumothorax and hemothorax in 21 cases (35.6%). The second most common complication was acute kidney injury (AKI) in six cases (10.2%), and neurological complications took place in three cases (5.1%). The 30-day mortality rate was 15.3% and the 1-, 3- and 5-year survival rates were 96.0%, 84.0%, and 76.0%, respectively.
Conclusions: The recurrence of dissection is the main cause of TAR after proximal aortic surgery, followed by aneurysm and the resurgical criteria for aneurysm needs to be unified. In addition to TAR, SET also is widely used. Despite high early mortality, its long-term prognosis is acceptable.
References
Bachet JE, Termignon JL, Dreyfus G, et al. 1994. Aortic dissection. Prevalence, cause, and results of late reoperations. J Thorac Cardiovasc Surg.1082:199-205; discussion-6.
Bradley TJ, Alvarez NA, Horne SG. 2016. A practical guide to clinical management of thoracic aortic disease. Can J Cardiol. 321:124-30.
Chen Y, Zhang S, Liu L, et al. 2017. Retrograde type a aortic dissection after thoracic endovascular aortic repair: A systematic review and meta-analysis. J Am Heart Assoc. 69.
Concistrè G, Casali G, Santaniello E, et al. 2012. Reoperation after surgical correction of acute type a aortic dissection: Risk factor analysis. Ann Thorac Surg. 932:450-5.
Conzelmann LO, Weigang E, Mehlhorn U, et al. 2016. Mortality in patients with acute aortic dissection type a: Analysis of pre- and intraoperative risk factors from the german registry for acute aortic dissection type a (geraada). Eur J Cardiothorac Surg. 492:e44-52.
David TE, Feindel CM, David CM, Manlhiot C. 2014. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg. 1483:872-9; discussion 9-80.
Di Eusanio M, Berretta P, Bissoni L, et al. 2011. 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. 405:1072-6.
Erbel R, Aboyans V, Boileau C, et al. 2014. 2014 esc guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology (esc). Eur Heart J. 3541:2873-926.
Estrera AL, Miller CC, 3rd, Villa MA, et al. 2007. Proximal reoperations after repaired acute type a aortic dissection. Ann Thorac Surg. 835:1603-8; discussion 8-9.
Fattouch K, Sampognaro R, Navarra E, et al. 2009. Long-term results after repair of type a acute aortic dissection according to false lumen patency. Ann Thorac Surg. 884:1244-50.
Geirsson A, Bavaria JE, Swarr D, et al. 2007. Fate of the residual distal and proximal aorta after acute type a dissection repair using a contemporary surgical reconstruction algorithm. Ann Thorac Surg. 846:1955-64; discussion -64.
Hagan PG, Nienaber CA, Isselbacher EM, et al. 2000. The international registry of acute aortic dissection (irad): New insights into an old disease. Jama. 2837:897-903.
Halstead JC, Meier M, Etz C, et al. 2007. The fate of the distal aorta after repair of acute type a aortic dissection. J Thorac Cardiovasc Surg. 1331:127-35.
Heo W, Song SW, Kim TH, et al. 2019. Differential impact of intimal tear location on aortic dilation and reintervention in acute type i aortic dissection after total arch replacement. J Thorac Cardiovasc Surg. 1582:327-38.e2.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010. 2010 accf/aha/aats/acr/asa/sca/scai/sir/sts/svm guidelines for the diagnosis and management of patients with thoracic aortic disease: A report of the american college of cardiology foundation/american heart association task force on practice guidelines, american association for thoracic surgery, american college of radiology, american stroke association, society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, society of interventional radiology, society of thoracic surgeons, and society for vascular medicine. Circulation. 12113:e266-369.
Inoue Y, Matsuda H, Omura A, et al. 2018. Long-term outcomes of total arch replacement with the non-frozen elephant trunk technique for stanford type a acute aortic dissection. Interact Cardiovasc Thorac Surg. 273:455-60.
Januzzi JL, Sabatine MS, Eagle KA, et al. 2002. Iatrogenic aortic dissection. Am J Cardiol. 895:623-6.
Karck M, Kamiya H. 2008. Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch? Eur J Cardiothorac Surg. 336:1007-13.
Kimura N, Itoh S, Yuri K, et al. 2015. Reoperation for enlargement of the distal aorta after initial surgery for acute type a aortic dissection. J Thorac Cardiovasc Surg. 1492 Suppl:S91-8.e1.
Kobuch R, Hilker M, Rupprecht L, et al. 2012. Late reoperations after repaired acute type a aortic dissection. J Thorac Cardiovasc Surg. 1442:300-7.
Kouchoukos NT, Kulik A, Castner CF. 2018. Clinical outcomes and rates of aortic growth and reoperation after 1-stage repair of extensive chronic thoracic aortic dissection. J Thorac Cardiovasc Surg. 1555:1926-35.
Minami H, Miyahara S, Okada K, et al. 2015. Clinical outcomes of combined aortic root reimplantation technique and total arch replacement. Eur J Cardiothorac Surg. 481:152-7.
Minatoya K, Inoue Y, Sasaki H, et al. 2019. Total arch replacement using a 4-branched graft with antegrade cerebral perfusion. J Thorac Cardiovasc Surg. 1574:1370-8.
Nishi H, Mitsuno M, Tanaka H, et al. 2010. Late reoperations after repair of acute type a aortic dissection. J Card Surg. 252:208-13.
Pan E, Gudbjartsson T, Ahlsson A, et al. 2018. Low rate of reoperations after acute type a aortic dissection repair from the nordic consortium registry. J Thorac Cardiovasc Surg. 1563:939-48.
Prenger K, Pieters F, Cheriex E. 1994. Aortic dissection after aortic valve replacement: Incidence and consequences for strategy. J Card Surg. 95:495-8; discussion 8-9.
Rampoldi V, Trimarchi S, Eagle KA, et al. 2007. Simple risk models to predict surgical mortality in acute type a aortic dissection: The international registry of acute aortic dissection score. Ann Thorac Surg. 831:55-61.
Rylski B, Hahn N, Beyersdorf F, et al. 2017. Fate of the dissected aortic arch after ascending replacement in type a aortic dissection†. Eur J Cardiothorac Surg. 516:1127-34.
Rylski B, Milewski RK, Bavaria JE, et al. 2014. Long-term results of aggressive hemiarch replacement in 534 patients with type a aortic dissection. J Thorac Cardiovasc Surg. 1486:2981-5.
Sievers HH, Richardt D, Diwoky M, et al. 2018. Survival and reoperation after valve-sparing root replacement and root repair in acute type a dissection. J Thorac Cardiovasc Surg. 1566:2076-82.e2.
Sun G, Sun L, Zhu J, et al. 2019. Efficacy of total aortic arch replacement combined with frozen elephant trunk in aortic reoperation. Med Sci Monit. 253998-4004.
Sun L, Qi R, Zhu J, Liu Y, Zheng J. 2011. Total arch replacement combined with stented elephant trunk implantation: A new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation. 1239:971-8.
Suzuki T, Asai T, Kinoshita T. 2018. Predictors for late reoperation after surgical repair of acute type a aortic dissection. Ann Thorac Surg. 1061:63-9.
Upchurch GR, Jr., Escobar GA, Azizzadeh A, et al. 2021. Society for vascular surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 731s:55s-83s.
von Kodolitsch Y, Simic O, Bregenzer T, et al. 1998. [aortic valve replacement as an independent predictive factor for later development of aortic dissection]. Z Kardiol. 878:604-12.
Wang H, Wagner M, Benrashid E, et al. 2017. Outcomes of reoperation after acute type a aortic dissection: Implications for index repair strategy. J Am Heart Assoc. 610.
Zhang L, Li Z, Li S, et al. 2019. Systematic review of endovascular repair of ascending aortic dissection. Catheter Cardiovasc Interv. 947:1018-25.
