Type A aortic dissection after previous cardiac surgery: results of an integrated surgical approach.

BACKGROUND: Stanford type A aortic dissection in patients with previous cardiac surgery (PCS) is a catastrophic disease. This investigation evaluates the results of a standardized integrated approach to type A dissection after PCS.

METHODS: Between 1993 and 2013, 629 patients with acute type A dissection (median age 61 [50 to 73] years, 64% males) underwent aortic repair utilizing a standardized integrated approach. Of these, 56 (9%) patients had PCS. Median follow-up was 4.1 (1.9 to 7.4) years (2,812 patient-years).

RESULTS: Patients with PCS were older (70 [60 to 75] vs 60 [50 to 72] years, p<0.001), fivefold more likely to have coronary artery disease (p<0.001), and threefold less likely to have cardiac tamponade (p<0.001). They had higher in-hospital mortality rate (25% vs 12%, p=0.011), similar postoperative stroke rate (4% vs 5%, p=0.821), and lower survival (60%±7%, 50%±7%, 38%±8% vs 84%±2%, 69%±2%, 50%±3%) at 1, 5, and 10 years, respectively (log rank, p=0.003). Among PCS patients, the lowest in-hospital mortality was in those without prior myocardial revascularization (11% vs 32%, p=0.185). Coronary malperfusion (odds ratio, 9.47; p=0.034) and cardiac tamponade (odds ratio, 5.01; p=0.076) were independent in-hospital mortality risk factors in PCS patients.

CONCLUSIONS: Standardized integrated approach to acute type A aortic dissection in PCS patients results in acceptable postoperative mortality. Previous cardiac surgery should not be a reason to deny surgical repair in patients with type A dissection.