Repair of residual aortic dissection after type a aortic dissection repair: a systematic review

The outcomes after surgical repair of acute type A aortic dissection (aTAAD) have steadily improved during the last decades. However, a substantial number of patients need for secondary repair due to the residual aortic dissection (RAD). The managements of RAD after aTAAD repair are challenging and optimal repair strategies remain controversial. We conducted MEDLINE and EMBASE database searches up to December 2023 for studies on the management of RAD after aTAAD repair. A systematic review was performed and both employed repair strategies and outcomes were evaluated. 21 studies were deemed eligible for this review published between 2007 and 2023. A total of 452 patients, (mean age: 54.6 ± 12.5 years), underwent re-intervention for RAD after aTAAD repair were identified. The overall 30-day mortality was 4.2%. Mean follow-up time was 31 ± 27 months. Three management strategies (open repair [n = 87, 19.2%], endovascular intervention [n = 181, 40.1%], hybrid operation [n = 184, 40.7%]) for RAD after aTAAD were recognized. These various strategies showed 30-day mortality rates of 5.6%, 0.6% and 7.1%, respectively (p = 0.002). The overall stroke rate was 2.4% (5.6% for the open repair group, 0 for the endovascular group, and 3.3% for the hybrid group; p = 0.005). Nine patients (4.2%) suffered acute renal failure: 5.6% (5 of 87) with open repair, 0.6% (1 of 181) with endovascular intervention, and 1.6% (3 of 184) with hybrid operation (p = 0.031). The available literature on management of RAD after aTAAD repair still consists of retrospective and heterogeneous case series. Despite endovascular intervention appears as a lower morbi-mortality rate in selected patients, general conclusion on the superiority of different management from solid statistical analysis is lacking. In regards to variable clinical features and pathology of RAD after aTAAD repair, an individualized approach is recommended.