Re-interventions on the proximal thoracic aorta: in-hospital and long-term outcomes (reprint)

Aim: the number of patients requiring repeat surgical interventions on the thoracic aorta, including the proximal thoracic aorta, is constantly increasing. These procedures are technically challenging and associated with a high risk of complications. We present our center's experience and surgical strategy for managing this patient population.

Materials and methods: from January 2011 to September 2022, 44 patients with prior cardiac surgery underwent proximal thoracic aortic reinterventions at the Federal Center for Cardiovascular Surgery (Chelyabinsk, Russia). The mean age at reoperation was 55,3±12,8 years. Indications for re-intervention were as follows: aortic aneurysm (n=17, 38.6%), aortic valve prosthesis dysfunction (n=10, 22.7%), native aortic valve disease (n=8, 18.2%), pseudoaneurysm (n=4, 9.1%), type A aortic dissection (n=2, 4.6%), and prosthetic endocarditis (n=3, 6.8%).

Results: hospital mortality was 2,3% (n=1), due to progressive multiorgan failure. Mean aortic cross-clamp and cardiopulmonary bypass (CPB) times were 151.4±42.1 min (range 69 - 245) and 240.9±63.5 min (range 141 - 390), respectively. Hypothermic circulatory arrest with antegrade cerebral perfusion was required in 13 patients (29.5%), with a mean duration of 24.8±10.2 min (range 12 - 40). Resternotomy for excessive bleeding was performed in 3 patients (6.8%), while 8 (18.2%) required prolonged ventilation (>24 h). ICU and hospital stays averaged 8.3±14.6 days (range 3 - 100) and 23.1±15.9 days (range 10 - 111), respectively. All discharged patients completed follow-up (mean 42.2±26.6 months). Four late deaths occurred. Overall survival was 85.2%.

Conclusion: patients requiring redo surgery on the proximal thoracic aorta represent a high-risk cohort. Meticulous surgical planning, including considerations for re-access, cannulation strategy, and cerebral and myocardial protection, is crucial for achieving favorable in-hospital outcomes. Long-term follow-up remains essential for this patient population.

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