Aortic Reoperation and Late Survival Following Repair of Acute Type A Dissection.

Objectives

To identify factors that impact aortic reoperation and late survival following type A aortic dissection repair (ATAAD).

Methods

668 operative survivors of ATAAD repair (1984-2025) were followed for medications and blood pressure (BP) control up to 39.7 years postoperatively. BP control was categorized as good (<120/70mmHg; 26%), moderate (51%), or poor (>140/90mmHg; 23%). Aortic reoperations were classified as proximal or distal to the initial extent of repair.

Results

103(15.4%) patients underwent aortic reoperation at a median of 5.2 years [1 month-22 years]. Incidence of reoperation was 3.0% 1 year, 9.1% 5 years, 20.0% 10 years, and 23.8% 20 years. Cox proportional-hazards predictors of aortic reoperation were: tobacco use (HR, 2.0,P=.002), absence of diabetes (3.9,P=.02), connective tissue disorder (2.2, P=.01), closed distal, cross-clamped anastomosis (1.6,P=.05), absence of β-blockers (2.2,P=.002), and poor BP control (1.7,P=.001). Median time to proximal reoperation was 5.7 years and 4.9 years for distal reoperation. Poor BP control remained a risk for proximal (HR 2.5,P=0.001) and distal (HR 1.5,P=0.02) reoperation. Median survival time was 11.5 years with Kaplan-Meier estimated survival of 92% 1 year, 79% 5 years, 58% 10 years, and 13% at 25 years. Predictors of mortality were: advanced age (HR, 1.04,P<.001), female sex (1.5,P=.02), chronic lung disease (2.3,P<.001), stroke history (1.6,P=.04), chronic kidney disease (2.4,P<.001), diuretic usage (1.3,P=.04), and absence of ACE/ARB therapy (1.7,P<.001).

Conclusions

Poor BP control and absence of β-blockers were independently associated with a greater risk of reoperation, highlighting the importance of BP control after ATAAD repair.