Predictors for Late Reoperation After Surgical Repair of Acute Type A Aortic Dissection.

BACKGROUND: It is impossible to resolve all the problems of the entire diseased aorta with just one operation for acute type A aortic dissection, which requires additional surgical treatment in the long-term.

METHODS: From April 2004 to March 2017, 310 patients underwent surgical repair for acute type A aortic dissection at our institution. Of these, 32 (10.3%) died in the hospital. Of the 278 hospital survivors, 38 underwent late reoperation associated with aortic dissection during the follow-up period. We compared the 240 nonreoperation patients and the 38 reoperation patients to analyze risk factors for late reoperation after operations for acute type A dissection.

RESULTS: The mean duration from the initial operation to reoperation was 3.54 ± 3.0 years. The rates of actuarial freedom from reoperation were 96.9%, 83.2%, and 64.2% at 1, 5, and 10 years, respectively. The multivariate Cox proportional hazard regression analysis revealed the following as independent predictors of late reoperation: younger age, Marfan syndrome, nonprescription of β-blockers, greater diameter of the descending aorta, ratio of false lumen to true lumen of more than 1, limb malperfusion, and primary entry in the ascending aorta. Log-rank analysis revealed no difference in long-term survival between the two groups.

CONCLUSIONS: We found several risk factors for both late reoperation and death. Specifically, aortic diameter in the early phase after the initial operation and nonuse of β-blockers were strong predictors. The ratio of the false lumen to the true lumen may also be a new and useful indicator for late reoperation.