Aortic arch reoperation in a single centre: early and late results in 57 consecutive patients

OBJECTIVES: Aortic arch surgery following previous replacement of the ascending aorta has become more frequent due to the improved long-term survival of patients after the primary procedure and advances in the management of complex repeat cardiac procedures. We retrospectively analysed our results of redo aortic arch surgery. METHODS: Between January 1995 and December 2011, a total of 1022 patients underwent surgery on the ascending aorta with or without involvement of the aortic arch. Of these, 57 patients (5%) underwent reoperations involving the aortic arch. Indications for repeat aortic arch surgery included arch aneurysm in 50%, residual aortic dissection with aneurysmal formation in 38%, and graft infection in 9% of patients. One patient (1%) underwent previous heart transplantation. Nine patients (16%) had Marfan syndrome. RESULTS: Mean age was 55 ± 15 years and 23 patients (40%) were female. Logistic EuroSCORE-predicted risk of mortality was 38 ± 19%. The mean time interval between primary and redo surgery was 7.6 ± 7 years for aortic aneurysm and 4.4 ± 4 years in aortic dissection patients (P= 0.09). Total and partial arch replacements were performed in 52 and 47% of patients, respectively. Mean circulatory arrest time was 28.3 ± 22.1 min, with selective antegrade cerebral perfusion (SACP) utilized in 68% of patients. Overall incidence of stroke or transient neurological deficit was 15%. The 30-day mortality was 9% (n= 5). Multivariable logistic regression analysis revealed that previous type A aortic dissection was the only independent risk factor (OR 3.7, 95% CI 1.5–5.5, P= 0.01) for 30-day mortality. Mean survival was 5.5 ± 0.5 years, and estimated 5-year survival was 74.9 ± 0.6%. Survival of patients undergoing reoperation for residual aortic dissection was significantly worse compared with patients with aortic arch aneurysm (log-rank P= 0.016). CONCLUSIONS: Aortic arch reoperation, although a technically complex operation, can be performed with acceptable mortality and morbidity. Patients with aortic dissection during their previous operation required repeat surgery significantly earlier when compared with patients with arch aneurysms, and had worse long-term survival.