Background: After years of experience in the field of aortic surgery the technique has evolved
making this procedure relatively safe with lasting results. Due to increasing long-term
survival and advanced follow-up techniques performed regularly, we are now able to
identify more patients with the need of a reoperation. As the general population ages,
the number of emergent reoperations rises. In the present study the safety of aortic
arch reoperations was analyzed in the long term, focusing on risk factors for adverse
outcome.
Methods: Between 1999 and 2023, 108 patients were included in our study who received a reoperation
on the aortic arch at our institution after initial operation on the thoracic aorta
with or without aortic valve replacement. Exclusion criteria was age under 18 years
and transcatheter aortic valve implantation as previous intervention. Primary endpoints
were death or freedom from cardiac re-reoperation. Secondary endpoints included major
bleeding, cardiac re-intervention, new aortic dissection, infective endocarditis,
readmission due to cardiac cause, cardiovascular and cerebral complications, pacemaker
implantation, and need for temporary mechanical circulatory support.
Results: In our study we found age (p = 0.02), history of coronary artery disease (0.049), and chronic kidney disease (≤0.01)
as preoperative risk factors for adverse outcome. The diagnosis of dilatation was
significantly higher in the group of diseased patients (p = 0.03). A procedure on the descending aorta at reoperation was linked to a worse
outcome (p = 0.05). A main risk factor was the urgency of the intervention (p = 0.03). Emergency operations showed a lower overall survival. Also, longer operation
time (p = 0.02), longer reperfusion time (p = 0.002), and the need for transfusion (p = 0.03) were linked to adverse outcome. The overall survival was 82% after 1 year,
73% after 5 years, and 56% after 10 years. In the COX regression analysis age was
found as a significant risk factor for adverse outcome (p ≤ 0.001). In the performed ROC analysis age over 57.5 years showed a significant
lower overall survival (p ≤ 0.001).
Conclusion: In the observed patients collective mortality was mainly influenced by the perioperative
phase while patients demonstrated a good survival rate after discharge. Aside from
well-known risk factors such as emergency operations and long operation time, age
is a significant outcome driver. A cut-off value of 57.5 years is a strong potential
predictor of adverse outcome.
