Outcomes of Reoperative Aortic Surgery Following Acute Type A Aortic Dissection Repair

Objectives Little is known regarding outcomes of aortic surgery following acute type A aortic dissection (ATAAD) repair. We aimed to assess outcomes of open aortic reoperations following ATAAD repair. Methods All aortic reoperations at a single institution (2005–2024) following prior ATAAD repair were reviewed. Outcomes included mortality, stroke, and renal failure. Survival was assessed by Kaplan–Meier analysis. Results A total of 237 patients were identified (mean 52.6 ± 11.9 years, 70.5% male). In the proximal cohort ( n = 121), indications for surgery included aneurysmal degeneration (69.9%), valve/graft infection (11.5%), valve dysfunction (6.2%), and multiple factors (8.9%). Procedures consisted of 70 (57.6%) total arch replacement ± elephant trunk procedures, 17 (14.0%) aortic root/hemiarch replacements, 16 (13.2%) isolated aortic root replacements, 9 (7.4%) ascending/hemiarch replacements, and 4 (3.3%) isolated aortic valve replacements. Operative mortality for proximal reoperations was 18.2%; the incidence of stroke and renal failure was 3.4% and 13.6%, respectively. In the distal cohort ( n = 116), 48 (41.4%) patients underwent isolated descending replacement, 46 (39.7%) underwent thoracoabdominal replacement, and 22 (19.0%) underwent thoracic endovascular aortic repair. Operative mortality was 13.8%; the incidence of stroke and renal failure was 1.7% and 7.8%, respectively. Among the entire cohort, overall 1‐ and 5‐year postoperative survival was 80.1% and 69.3%, respectively. Conclusions Elective reoperation for aneurysmal degeneration or aortic valve dysfunction following ATAAD can be performed with acceptable morbidity and mid‐term survival. This data are essential to serve as a reference point for ongoing clinical trials of endovascular therapy to treat aneurysms secondary to chronic dissection following ATAAD repair.