Preoperative Risk Factors for Reintervention after Aortic Repair for a Type A Aortic Dissection

Objectives: Following aortic surgery of patients with Stanford type A aortic dissections (TAD), reinterventions are frequently necessary mainly due to residual dissections. This study aimed to analyze patients who underwent reinterventions after prior aortic surgery and to identify possible risk factors especially in the pre- and perioperative setting.

Methods: Between 01/01/1998 and 01/03/2020, complete data of 529 patients with acute and chronic TAD and subsequent aortic surgery were obtained for a retrospective data analysis. Risk factors for future reinterventions were identified using a multivariate logistic regression model.

Result: Mean age was 61.4 ± 13.5 years and 67.3% (n = 356) of the patients were male. Chronic TAD was present in 16.1% (n = 85) of all patients. Patients underwent root replacement (24.0%, n = 127), isolated supracoronary ascending replacement (9.6%, n = 51), hemi-arch replacement (40.8%, n = 216), total arch replacement (25.5%, n = 135), or frozen elephant trunk (FET) procedures (16.3%, n = 86) as initial surgery. Mean follow-up time was 18.9 ± 31.3 months. During the study period, 84 patients (16.9%) needed aortic reintervention, which were either surgical (n = 32) or endovascular (n = 52). Multivariate logistic regression analysis revealed FET technique (OR = 0.437, 95% CI: 0.205–0.930, p = 0.032) and chronic aortic dissection (OR = 0.437, 95% CI: 0.195–0.982, p = 0.048) as independent protective factors against reinterventions. Residual dissection was identified as an independent risk factor (OR = 2.061, 95% CI: 1.007–4.220, p = 0.48) for reintervention, whereas gender and genetic aortic syndrome (GAS) did not show any influence on the need for reintervention (gender: p = 0.106; GAS: p = 0.784).

Conclusion: In this patient collective, postoperative residual dissection was identified as an independent risk factor for reinterventions after surgical repair for TAD, whereas chronic TAD and FET were identified as protective factors against reinterventions. Hence, FET should be favored especially in hemodynamically stable patients and in elective treatment of patients with chronic dissections to minimize the need for reinterventions after prior surgery.

Publication History

Article published online:
19 February 2021