Reoperation after repair of type A and B dissecting aneurysm

Background. In the late postoperative period after repair of an aortic diss ection or dissecting aneurysm, reoperations may be required. The interval t o reoperation, size and location of intimal tear, and results of reoperatio n were evaluated. Methods. Between January 1982 and April 1997, 138 patients underwent surger y for Stanford type A (90 patients) or type B (48 patients) dissections of the aorta. The entire aorta was evaluated in postoperative follow-up by com puted tomography and magnetic resonance imaging for 6 months to 15 years. R eoperations were performed in 14 (10.1%) patients with changes in the aneur ysms at the site of the initial repair or in the distal aorta. Selective ce rebral perfusion or retrograde cerebral perfusion with deep hypothermia was used in the repair of the ascending, arch, and distal arch aneurysms. Reop erations included aortic root reconstruction (n=3), resection of a pseudoan eurysm (n=1), and replacement of the ascending aorta (n=1), arch (n=5), des cending aorta (n=2), thoracoabdominal aorta (n=1), or abdominal aorta (n=1) . Secondary reoperations were performed in four patients (replacement of th e arch [n=2], thoracoabdominal aorta and abdominal aorta). Consequently two patients had subtotal aortic replacements. The aneurysms were caused by an anastomotic leak, a new intimal tear following aortic crossclamping, a sec ond intimal tear in the distal arch or abdominal aorta, and Marfan syndrome . Results. Two patients (2/18 11.1%) died of bleeding or low output syndrome. Two patients died of graft infection or prosthetic valve infection 3 month s after surgery respectively. Conclusions. 1) The surgical results of reoperation for type A and B dissec tions were good. 2) Close postoperative follow-up of the patent false lumen in the entire aorta was necessary. 3) At the initial operation, total rese ction of the intimal tear in the aortic arch in low-risk patients reduced t he risk of reoperation.