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Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy.

Publication ,  Conference
Wang, H; Wagner, M; Benrashid, E; Keenan, J; Wang, A; Ranney, D; Yerokun, B; Gaca, JG; McCann, RL; Hughes, GC
Published in: J Am Heart Assoc
October 3, 2017

BACKGROUND: The optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy. METHODS AND RESULTS: All aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes included organ-specific morbidity and 1- and 5-year outcomes as estimated using the Kaplan-Meier method. The majority of initial reoperations were proximal aortic (aortic valve, aortic root, or ascending) or aortic arch procedures (62.5%, n=55); most initial reoperations were performed in the elective setting (83.1%, n=74). Additional nonstaged second or more reoperations were required in 21 patients (23.6%) after the initial reoperation, during a median follow-up of 2.5 years after the initial reoperation. Thirty-day or in-hospital mortality for all reoperations was 7.0% (elective: 6.3%; nonelective: 11.1%) with acceptable rates of organ-specific morbidity, given the procedural complexity. One- and 5-year overall survival after initial reoperation was 85.9% and 64.9%, respectively, with aorta-specific survival of 88% at 5 years. CONCLUSIONS: Reoperation after acute type A aortic dissection repair is associated with low rates of mortality and morbidity. These data support more limited index repair for acute type A dissection, especially for patients undergoing index repair in lower volume centers without expertise in extensive repair, because reoperations, if needed, can be performed safely in referral aortic centers.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

October 3, 2017

Volume

6

Issue

10

Location

England

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • North Carolina
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

Citation

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Chicago
ICMJE
MLA
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Wang, H., Wagner, M., Benrashid, E., Keenan, J., Wang, A., Ranney, D., … Hughes, G. C. (2017). Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy. In J Am Heart Assoc (Vol. 6). England. https://doi.org/10.1161/JAHA.117.006376
Wang, Hanghang, Matthew Wagner, Ehsan Benrashid, Jeffrey Keenan, Alice Wang, David Ranney, Babatunde Yerokun, Jeffrey G. Gaca, Richard L. McCann, and G Chad Hughes. “Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy.” In J Am Heart Assoc, Vol. 6, 2017. https://doi.org/10.1161/JAHA.117.006376.
Wang H, Wagner M, Benrashid E, Keenan J, Wang A, Ranney D, et al. Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy. In: J Am Heart Assoc. 2017.
Wang, Hanghang, et al. “Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy.J Am Heart Assoc, vol. 6, no. 10, 2017. Pubmed, doi:10.1161/JAHA.117.006376.
Wang H, Wagner M, Benrashid E, Keenan J, Wang A, Ranney D, Yerokun B, Gaca JG, McCann RL, Hughes GC. Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy. J Am Heart Assoc. 2017.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

October 3, 2017

Volume

6

Issue

10

Location

England

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • North Carolina
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate