Repeat surgical intervention after aortic repair for acute Stanford type A dissection
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This study aimed to evaluate the outcomes of repeat interventions on the aorta and aortic valve after surgery for acute Stanford type A aortic dissection.
The hospital records of patients who underwent repeat surgical intervention between April 2011 and March 2017 for late complications after acute type A aortic dissection repair were retrospectively reviewed.
We identified 17 patients with mean age of 62 ± 8 years; 13 were men. The mean interval from the initial emergency aortic repair to the repeat intervention was 5.8 ± 5.4 years (range 133 days–16.6 years). Ten patients had dilatation or rupture of the residual type B aortic dissection; six of them had retrograde type A aortic dissection at the onset and did not undergo resection of the primary entry. Five patients had a pseudoaneurysm at the anastomosis; four of them were receiving anticoagulation medication. Three patients had aortic regurgitation; two of them were associated with the gelatin-resorcinol-formaldehyde glue that was used during the initial surgery. There was no early mortality after repeat intervention and no late death after a mean follow-up period of 3.3 ± 2.0 years.
Repeat surgical intervention on the aorta and aortic valve after repair of acute type A aortic dissection had favorable early and mid-term outcomes and was not associated with early or late death. Long-term follow-up with imaging and echocardiography was considered to be essential for early detection of residual type B dilatation, anastomotic pseudoaneurysm, and aortic regurgitation after initial aortic repair.
KeywordsAortic dissection Aortic aneurysm Pseudoaneurysm Aortic regurgitation Reoperation
We thank Dr. Masashi Akiya, Department of Pathology, Kitasato University School of Medicine, for his assistance in the interpretation of the pathological findings.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 5.Okita Y, Okada Y, Otsuji Y, Komeda M, Nakatani S, Matsuzaki M, et al. Guidelines for surgical and interventional treatment of valvular heart disease (JCS 2012). 2018. http://www.j-circ.or.jp/guideline/pdf/JCS2012_ookita_h.pdf. Accessed 22 Apr 2018.
- 7.Yamane Y, Uchida N, Mochizuki S, Furukawa T, Yamada K. Early- and mid-term aortic remodelling after the frozen elephant trunk technique for retrograde type A acute aortic dissection using the new Japanese J Graft open stent graft. Interact Cardiovasc Thorac Surg. 2017;25:720–6.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Iafrancesco M, Goebel N, Mascaro J, Franke UFW, Pacini D, Di Bartolomeo R, et al. International E-vita Open Registry Group. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: results from an international multicentre registry. Eur J Cardiothorac Surg. 2017;52:310–8.CrossRefPubMedGoogle Scholar
- 12.Inoue Y, Matsuda H, Omura A, Seike Y, Uehara K, Sasaki H, et al. What is the optimal surgical strategy for Stanford Type A acute aortic dissection in patients with a patent false lumen at the descending aorta? [published online ahead of print March 28, 2018]. Eur J Cardiothorac Surg. 2018. https://doi.org/10.1093/ejcts/ezy125.CrossRefPubMedGoogle Scholar