Reinterventions after Surgery for Chronic Aortic Dissections

Background: In patients undergoing FET surgery for chronic aortic dissections (CAD), secondary interventions may become necessary to treat the remaining aortic disease.

We sought to analyze outcome and rate of reinterventions after initial FET surgery for chronic type A or B aortic dissections.

Method: From January 2010 to February 2022, a total of 54 patients underwent FET surgery for CAD at our center. Follow-up including CT or MRI imaging was performed after 3 and 12 months and thereafter depending on the progression of the remaining aortic pathology. The indication for reintervention was consented in an interdisciplinary case conference.

All procedural and follow-up data were inserted into a database and retrospectively analyzed.

Results: Mean age was 56.7 ± 12.0 years with 70.4% male patients. EuroSCORE II was 8.7 ± 8.4%. Underlying heritable thoracic aortic disease was present in 21 patients (38.9%).

During FET procedure, concomitant surgery on the aortic root was necessary in 11 patients (20.4%) and 3 (5.6%) received concomitant coronary artery bypass grafting. Simplified FET surgery with distal anastomosis in aortic arch zone 2 was performed in 32 patients (59.3%).

After FET surgery 30-day mortality rate was 3.7%.

During follow-up, 25 patients (46.3%) received at least one secondary aortic intervention for exclusion of false lumen perfusion and remaining thoracoabdominal aneurysm. Type of secondary intervention was endovascular in 22 with 18 thoracic and 4 thoracoabdominal aortic stent implantations. Additionally, complete thoracoabdominal repair (Crawford procedure) was performed in 3 patients, all suffering from connective tissue disorder.

Freedom from reintervention 1 and 5 years after FET procedure for CAD was 51.5 and 25.8%, respectively, as shown in Kaplan–Meier analysis.

Five-year survival rates after initial FET surgery were 86.2% in patients without reinterventions versus 77.4% in patients with reinterventions (log-rank p = 0.90).

Conclusion: Elective FET surgery for chronic aortic dissections is associated with low rates of early postoperative mortality. Secondary interventions after FET surgery for CAD affecting the whole aorta are frequently necessary to exclude false lumen perfusion. To achieve satisfactory long-term survival rates, regular follow-up including serial imaging and a multidisciplinary aortic center approach is paramount for early detection and treatment of progression of the aortic pathology.

Publication History

Article published online:
28 January 2023