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Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis

Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis. G. Concistrè, MD, E. Santaniello, MD, G. Casali, MD, A. Montalto, MD, B. Fiorani, MD, A. Loforte, MD, A. Dell’Aquila, MD, F. Musumeci, MD Department of Cardiac Surgery and Heart Transplantation

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Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis

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  1. Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis G. Concistrè, MD, E. Santaniello, MD, G. Casali, MD, A. Montalto, MD, B. Fiorani, MD, A. Loforte, MD, A. Dell’Aquila, MD, F. Musumeci, MD Department of Cardiac Surgery and Heart Transplantation San Camillo Hospital Rome, Italy Aortic Symposium 2010, NYC

  2. Objective of Study To evaluate significant risk factors for reoperations after surgical correction of acute type A aortic dissection Aortic Symposium 2010, NYC

  3. Methods of Study • Retrospective review of 251 consecutive patients operated for acute type A aortic dissection at our Institution between 1998 and 2008. • Twenty-five patients required 25 reoperation at a mean interval of 4.7 years after initial operation. Aortic Symposium 2010, NYC

  4. Survival after Initial Operation 1 yrs = 77 ± 3% 5 yrs = 73 ± 3% 14 yrs = 62 ± 5% Aortic Symposium 2010, NYC

  5. Freedom from reoperation 1 yrs = 99 ± 0.8% 5 yrs = 82 ± 3% 10 yrs = 79 ± 4% Aortic Symposium 2010, NYC

  6. Clinical Profile of Reoperations • 25 patients • Sex: 84% men • Mean age: 62.5 ± 12.4 years • Marfan syndrome: 4% Aortic Symposium 2010, NYC

  7. Causes of Reoperations • Pseudoaneurysm of the proximal and/or distal • anastomosis 13 (52%) • Aortic valve regurgitation (AVR) 3 (12%) • Aortic root aneurysm 3 (12%) • Aortic arch aneurysm 3 (12%) • Aortic root aneurysm + AVR 2 (8%) • Descending aorta aneurysm 1 (4%) Aortic Symposium 2010, NYC

  8. Operation Performed • Bentall procedure 13 (52%) • Ascending aorta replacement 6 (24%) • Total arch replacement 3 (12%) • Aortic valve replacement 2 (8%) • Descending aorta replacement 1 (4%) Aortic Symposium 2010, NYC

  9. Follow-up • Mean follow-up: 4.7 years, ranging from 0 to 14 • years • 98% complete • 3 (12%) late deaths Aortic Symposium 2010, NYC

  10. Risk Factors for Reoperations • Multivariate Cox regression analysis identified: • Patent false lumen (p = 0.0107) • Use of surgical glue (p = 0.0270) • Not aortic root replacement (p = 0.0004) • as risk factors for reoperation Aortic Symposium 2010, NYC

  11. Conclusions Use of GRF glue and aortic root preservation at initial operation influence the risk of new surgical correction in patients operated of acute type A aortic dissection. These patients need a long term follow-up. Aortic Symposium 2010, NYC

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