Early- and mid-term outcomes following redo aortic surgeries: a retrospective cohort study

Abstract Background Redo aortic surgeries are complex procedures known to be associated with increased morbidity and mortality compared to patients who undergo de novo aortic procedures. We aimed to report the survival and outcomes following redo aortic surgeries in our centre. We performed a retrospective cohort study of 77 patients who underwent redo aortic surgery between January 1st, 2018, and August 30th, 2023. The primary outcome of interest was operative mortality. Other secondary outcomes of interest included overall mortality, survival rates, and other peri-operative major adverse events. Survival analysis was performed and Cox- proportional hazard regression models were fitted to explore the relationship between exposure variables and outcomes of interest in the total cohort of patients. Results The mean age of the total cohort was 64.22 ± 12.22 years with majority being males ( n = 57, 69.3%). The most common indication for redo surgery was aortic aneurysm ( n = 41, 53.2%) and majority of the patients had a first redo aortic surgery ( n = 69, 89.6%). The rate of freedom from in-hospital mortality was 63.1% (95% confidence interval (CI) 35.4–100%). Overall survival rate during the 5-year study period was 73.1% (95% CI 62.6–85.4%) in the whole cohort. The factors found to be predictive of overall mortality were priority of surgery hazard ratio (HR) 3.48 (95% CI 1.20–10.05, p = 0.02), time to re-operation HR 0.89 (95% CI 0.81–0.99, p = 0.025), pre-operative chronic kidney disease HR 3.16 (95% CI 1.18–8.43, p = 0.022), need for mechanical circulatory support HR 12.7 (95% CI 4.23–38.12, P < 0.001), post-operative renal dysfunction requiring hemofiltration HR 4.03 (95% CI 1.50–10.79, p = 0.006), and post-op re-exploration HR 47.82 (95% CI 13.9–164.4, p < 0.001). Conclusions Our study shows that short-term and mid-term outcomes following redo aortic surgery are favourable. The factors found to be associated with overall mortality include post-op re-exploration, renal dysfunction, use of post-op mechanical circulatory support, priority of surgery, and time to re-operation. Graphical Abstract Summary of outcomes following redo aortic surgery over a 5-year period (2018–2013). CI, confidence interval; HR, hazard ratio; CKD, chronic kidney disease, AKI, acute kidney injury, MCS, mechanical circulatory support.