Acute Type A Aortic Dissection after Previous Cardiac Surgery

Background: Acute type A aortic dissection ATAAD alone is a live threatening diagnosis. Aortic dissection after previous cardiac surgery PCS makes the surgical approach even more difficult. The reports are few and the numbers of patients analyzed generally small. We analyzed the postoperative outcome of patients with acute Stanford A dissection after PCS that presented in our institution.

Method: Between 2004 and 2017 we operated on 1079 Patients with acute type A aortic dissection. 21 (1.94%) (4 female, 17 male) of these patients underwent previous cardiac surgery. The previous procedures included 4 (19%) coronary surgeries, 7 (33.3%) valve procedures, 3 (14%) aortic surgeries, 3 (14%) endovascular procedures, 3 (14%) combined procedures, and 1 (4.76%) 1 TF TAVI.

Results: The patients with ATAAD after previous cardiac surgery were slightly older than the group with aortic dissection as first diagnosis (65 [56 to 74] vs 63 [60 to 76] years. On average 74 months passed between the first surgery and the ATAAD. Bypass time as well as aortic clamp time was longer in the redo operations (151/96min) (70/ 49min). As far as the 30 day mortality is concerned the outcome in the group with reoperation was better (4.7 vs. 6.9%). 1 (4.74%) patient in the redo group needed hemodialysis versus 85 (7.9%) in the group with aortic repair as first procedure. Neurological complications occurred in 2 (9.5%) versus 40 (3.7%).

Conclusion: Acute type A aortic dissection as a redo operation are surgically challenging but can be done with acceptable outcome. In our group of investigated patients the mortality in the subgroup of redo surgeries was lower than in the group of patient with ATAAD as a first diagnosis. While the bypass time and aortic clamp time were longer and the rate of neurological complications was higher the percentage of patients requiring dialysis was lower.