TY - JOUR AU - Elbayomi, Mohamed AU - Weyand, Michael AU - Pathare, Presheet AU - Nooh, Ehab AU - Harig, Frank PY - 2023/03/03 Y2 - 2024/03/28 TI - Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair JF - The Heart Surgery Forum JA - HSF VL - 26 IS - 2 SE - DO - 10.1532/hsf.5345 UR - https://journal.hsforum.com/index.php/HSF/article/view/5345 SP - E164-E169 AB - <p class="p1"><span class="s1"><strong>Background</strong>: The optimal management strategy for acute aortic type A dissection remains controversial. Whether a limited primary (index) repair would increase the need for late aortic reintervention is still an open debate.</span></p><p class="p1"><span class="s1"><strong>Methods</strong>: A total of 393 consecutive adult patients with acute type A aortic dissection who underwent cardiac surgery were analyzed. Our research hypothesis was whether limited aortic index repair (i.e., isolated aorta ascending replacement without an open distal anastomosis with and without a concomitant aortic valve replacement, including hemiarch replacement procedure) is associated with a higher incidence of late aortic reoperation compared with extended repair (i.e., any other surgical procedure that goes beyond that limited approach).</span></p><p class="p1"><span class="s1"><strong>Results</strong>: Type of the initial repair had no statically significant relationship with in-hospital mortality with a P-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (<em>P</em> = 0.4). From the patients who survived until discharge (<em>N</em> = 311), 40 patients needed a reoperation on the aorta; the mean interval until reoperation was 4.5 years. The relationship between the type of the initial repair and the need for reoperation didn’t reach a statically significant value (<em>P</em> = 0.9). In-hospitable mortality after the second operation was 10% (<em>N</em> = 4).</span></p><p class="p1"><span class="s1"><strong>Conclusion</strong>: We reached two conclusions. 1) An extended prophylactic repair in the initial operation of an acute type A aortic dissection might not lead to a lower incidence of reoperations on the aorta and could increase in-hospital mortality by increasing cross-clamp time, and 2) Reoperation on the aorta could be done safely with acceptable mortality outcomes.</span></p> ER -