Type A Aortic Dissection After Previous Cardiac Surgery: Results of an Integrated Surgical Approach

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Abstract

Background.

Stanford type A aortic dissection in patients with previous cardiac surgery (PCS) is a catastrophic disease. This investigation evaluates the results of a standardized integrated approach to type A dissection after PCS.

Methods.

Between 1993 and 2013, 629 patients with acute type A dissection (median age 61 [50 to 73] years, 64% males) underwent aortic repair utilizing a standardized integrated approach. Of these, 56 (9%) patients had PCS. Median follow-up was 4.1 (1.9 to 7.4) years (2,812 patient-years).

Results.

Patients with PCS were older (70 [60 to 75] vs 60 [50 to 72] years,p< 0.001), fivefold more likely to have coronary artery disease (p< 0.001), and threefold less likely to have cardiac tamponade (p< 0.001). They had higher in-hospital mortality rate (25% vs 12%,p= 0.011), similar postoperative stroke rate (4% vs 5%,p= 0.821), and lower survival (60% ± 7%, 50% ± 7%, 38% ± 8% vs 84% ± 2%, 69% ± 2%, 50% ± 3%) at 1, 5, and 10 years, respectively (log rank,p= 0.003). Among PCS patients, the lowest in-hospital mortality was in those without prior myocardial revascularization (11% vs 32%,p= 0.185). Coronary malperfusion (odds ratio, 9.47;p= 0.034) and cardiac tamponade (odds ratio, 5.01;p= 0.076) were independent in-hospital mortality risk factors in PCS patients.

Conclusions.

Standardized integrated approach to acute type A aortic dissection in PCS patients results in acceptable postoperative mortality. Previous cardiac surgery should not be a reason to deny surgical repair in patients with type A dissection.

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