Aortic arch reoperation following replacement of the ascending aorta

Objective: Loss of compliance of the ascending aorta following its replacement with rigid vascular grafts may have an impact on the reoperation rate of the residual aorta. We retrospectively analyzed our results of aortic arch surgery following previous replacement of the ascending aorta.

Methods: Between January 2003 and November 2009, a total number of 636 patients underwent aortic arch replacement at out institution. From this group 42 patients (7%) had undergone previous replacement of the ascending aorta and are the subject of this study.

Results: Mean age was 56±14 years and 64% of patients were male. Indications for reoperations were: arch aneurysm 74%, dissections 17% and others (including two patients with Marfan Syndrome and two patients with endocarditis). Mean time interval between initial surgery and reoperation was 8.1±5.7 years in aortic aneurysms and 1.9±2.4 years in type A aortic dissections (p<0.01). Total arch replacement was performed in 55% and partial arch replacement in 45%. Thirty day mortality was 12% and stroke rate was 12%. Six-year survival was 73% with mean follow-up of 4.6±0.4 years.

Conclusions: Reoperations of the aortic arch following replacement of the ascending aorta are predominantly performed due to the development or progression of aneurismal disease. Patients with repair of type A aortic dissection underwent reoperation of the aortic arch significantly earlier compared to patient with aneurysm repair. Overall, redo-arch surgery can be performed with good outcomes.