Redo ascending aortic surgery: outcomes and risk factors of complications

Objective. To analyze the indications, early and mid-term outcomes of redo ascending aortic (AA) surgery, as well as risk factors of complications. Material and methods. We analyzed 1874 patients who underwent open AA surgery in our clinic between 01.01.2006 and 01.06.2023. Observational single-center retro-prospective study was devoted to evaluation of early and mid-term postoperative period. Exclusion criteria: unavailable postoperative follow-up data, emergency surgery, «non-aortic» indications for redo surgery. A group of 41 patients who underwent redo AA surgery was formed. Statistical analysis and searching for predictors of complications were performed using the PAST 4.0, integrated development environments Jupiter Notebook 5.7.8 and Google Colab, as well as the Python 3.8 programming language. Results. In-hospital mortality was 11.2% (n=5). The most common in-hospital complications were cardiovascular (32%, n=13) and respiratory failure (32%, n=13), cerebral circulatory disorders (15%, n=6). Risk factors of early postoperative complications were age, coronary artery disease, preoperative hemoglobin, aortic arch diameter, type of arterial cannulation and cardioplegia. Complete follow-up data were available for 36 (100%) patients (4—147 months). The annual and 5-year survival rates were 94.4% and 77.4%, respectively. Predictors of mortality in mid-term postoperative period were severity of chronic heart failure and age. Predictors of negative aortic remodeling were connective tissue disorders and patent false lumen. Conclusion. AA redo surgery is associated with high risk of complications and in-hospital mortality. Age, comorbidities and aortic arch diameter are non-modifiable risk factors of complications. Blood cardioplegia and cannulation of the right axillary artery can reduce the risks of cardiovascular failure and neurologic complications. Connective tissue disorders can justify more aggressive surgical approach.