Reoperation After Surgical Correction of Acute Type A Aortic Dissection: Risk Factor Analysis INVITED COMMENTARY

Background. Aortic dissection is an evolving process that may require one or several reoperations after its initial repair. We conducted a study to evaluate risk factors and define the incidence and locations of reoperations after surgical correction of acute type A aortic dissection (AAD). Methods. Between 1998 and 2008, 250 consecutive patients (mean age 62.5 +/- 12.4 years) underwent surgery for AAD at our institution. Replacement of the ascending aorta was done in 173 cases, composite graft replacement in 61 cases, separate aortic valve and ascending aorta replacement in 2 cases, and arch replacement required by distal repair in 14 cases. Mean follow-up time was 4.7 +/- 5.6 years. Results. Freedom from reoperation was 99%, 82%, and 79% at 1, 5, and 10 years, respectively. Twenty-five patients required 25 reoperations at a mean interval of 4.7 years after initial surgery for the correction of AAD. Reoperations included 21 procedures on the proximal aorta (ascending aorta, aortic root, or valve) and 4 procedures on the distal aorta (arch or descending aorta). Cox regression analysis identified the use of gelatin-resorcinol-formaldehyde (GRF) glue (p = 0.0270), and nonreplacement of the aortic root at the time of initial AAD repair (p = 0.0004), as a significant risk factor for proximal reoperation, and a patent false lumen (p = 0.0107) as a significant risk factor for distal reoperation. Conclusions. A patent false lumen, the use of GRF glue, and aortic root preservation at initial operation influence the risk for surgical correction in patients undergoing surgery for AAD. These patients need long-term follow-up. (Ann Thorac Surg 2012;93:450-6) (C) 2012 by The Society of Thoracic Surgeons