Impact of redo sternotomy on proximal aortic repair: Does previous aortic repair affect outcomes?

Sandhu, Harleen K.; Tanaka, Akiko; Zaidi, Syed Taha; Perlick, Alexa; Miller, Charles C.; Safi, Hazim J.; Estrera, Anthony L.

doi:10.1016/j.jtcvs.2019.04.089

Cited by 31 publications

(24 citation statements)

References 15 publications

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“…Although various technical improvements have been achieved, reoperative root or ascending replacement after previous cardiac procedures still remains a surgical challenge, with the mortality of 5.4% to 17.9% (3,(9)(10)(11)17,18,21,22). Only few studies calculated the mortality of reoperative root replacement in patients with prior AVR [Szeto et al 14.1% (18) and Esaki et al 14.1% (22)].…”

Section: Discussionmentioning

confidence: 99%

“…As the number of cardiac procedures accumulates and the patient population ages, it is not surprising that many patients will require redo operations on the aortic root or ascending aorta. However, reoperative root or ascending replacement after previous cardiac procedures is not only technically challenging, but also associated with increased mortality and morbidity when compared with primary root or ascending replacement (3).…”

Section: Introductionmentioning

confidence: 99%

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Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement

Dun¹,

Shi²,

Guo³

et al. 2021

J Thorac Dis

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Background: There are limited data regarding the clinical outcomes of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement (AVR). We aimed to analyze outcomes of reoperative aortic root or ascending aorta replacement after prior AVR. Methods: Eighty patients with prior AVR underwent reoperative aortic root or ascending aorta replacement in our hospital. The indications were root or ascending aortic aneurysm in 36 patients, root or ascending aortic dissection in 37, root false aneurysm in 2, prosthesis valve endocarditis (PVE) with root abscess in 2, Behçet's disease (BD) with root destruction in 3 patients. An elective surgery was performed in 63 patients and an emergent surgery in 17. The survival and freedom from aortic events during the followup were evaluated with the Kaplan-Meier survival curve and the log-rank test. Results: The operative techniques included ascending aorta replacement in 14 patients, ascending aorta replacement with AVR in 3, prosthesis-sparing root replacement (PSRR) in 35, Bentall procedure in 24, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/80). A composite of adverse events occurred in 5 patients, including 1 operative death, 2 stroke and 3 renal failure necessitating hemodialysis. The mean follow-up was 35.5±22.1 months. Five late deaths occurred. The Kaplan-Meier survival at 1 year, 3 years and 6 years were 97.5%, 91.1% and 84.1%, respectively. Aortic events developed in 3 patients. The freedom from aortic events at 1-year, 3-year, and 6-year were 100%, 96.3% and 88.9%, respectively. There were no differences in survival and freedom from aortic events between the elective group and the emergent group. Conclusions: Reoperative aortic root or ascending aorta replacement after prior AVR could be performed to treat the root or ascending pathologies after AVR, with satisfactory early and midterm outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement

Dun¹,

Shi²,

Guo³

et al. 2021

J Thorac Dis

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“…Представляется обоснованным мнение о том, что нерезецированные участки аневризматически измененной аорты являются структурно скомпрометированными, что может повлиять на результат в отсроченном периоде. Основной при-чиной повторных операций является прогрессирование аневризмы из-за неадекватной резекции патологически измененной аортальной стенки во время предыдущих операций [14,15].…”

Section: результатыunclassified

Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

et al. 2020

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Aim. To compare the shortand medium-term outcomes of hemiarch and nonhemiarch replacement for ascending aortic aneurysm (AAA).Material and methods. The study included 151 patients with non-syndromic AAA who underwent an elective replacement. Patients were divided into two groups: group 1 (non-hemiarch, n=40) — standard ascending aortic replacement; group 2 (hemiarch, n=111) — ascending aortic replacement with the hemiarch anastomosis in conditions of moderate hypothermia and circulatory arrest with unilateral antegrade cerebral perfusion. To eliminate systematic differences between the compared groups, the propensity score matching (PSM) method was used.Results. Before PSM, there were no significant intergroup differences in the incidence of neurological complications, myocardial infarction, prolonged ventilation, or acute kidney injury. Bleeding-related reoperation rates and hospital mortality significantly differed between groups. After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality. Median-term survival and freedom from aortic reoperations also did not show significant intergroup differences.Conclusion. Hemiarch replacement for AAA does not lead to an increase in the incidence of postoperative complications, as well as the risk of shortand mediumterm mortality compared with non-hemiarch.

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“…1,2 In ATAAD 9% to 16% of patients have had previous cardiac surgery (PCS), which is associated with an increased operative mortality (12-37%). [3][4][5][6][7] Open aortic repair is often more complex and challenging in patients with PCS because of the added risks of sternal reentry and presence of adhesions. ATAAD complicated by malperfusion syndrome (MPS), which is end tissue/organ necrosis and dysfunction due to end-organ malperfusion, is also traditionally treated with emergent open aortic repair and associated with an increased operative mortality (25%-44%).…”

mentioning

confidence: 99%

Managing Malperfusion Syndrome in Acute Type A Aortic Dissection With Previous Cardiac Surgery

Norton

Farhat

et al. 2021

The Annals of Thoracic Surgery

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Impact of redo sternotomy on proximal aortic repair: Does previous aortic repair affect outcomes?

Cited by 31 publications

References 15 publications

Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement

Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement

Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

Managing Malperfusion Syndrome in Acute Type A Aortic Dissection With Previous Cardiac Surgery

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