1. Impact of redo sternotomy on proximal aortic repair: Does previous aortic repair affect outcomes?
- Author
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Charles C. Miller, Anthony L. Estrera, Akiko Tanaka, Harleen K. Sandhu, Hazim J. Safi, Syed Taha Zaidi, and Alexa Perlick
- Subjects
Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Heart Diseases ,Aortic Rupture ,030204 cardiovascular system & hematology ,Aortic repair ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Aneurysm ,Risk Factors ,Interquartile range ,medicine ,Humans ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,Aortic dissection ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Aortic surgery ,Sternotomy ,Aortic Aneurysm ,Surgery ,Aortic Dissection ,Treatment Outcome ,Increased risk ,030228 respiratory system ,Acute type ,Acute Disease ,Chronic Disease ,Disease Progression ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Proximal aortic repair (AoR) in the setting of previous sternotomy may be associated with greater risk than primary repair. Our objective was to determine whether redo sternotomy increases the risk of adverse outcomes following proximal aortic surgery.We reviewed all proximal AoRs from 1991 to 2014. Outcomes were compared between first-time AoR (non-redo = 1305) and redo AoRs, which were further classified into 3 categories: (1) previous acute type A aortic dissection (AAD) repair (redo-AAD = 146, 8.3%); (2) previous proximal aneurysm repair (redo-aneurysm = 165, 9.4%); and (3) previous cardiac (non-aortic) sternotomy (redo-cardiac = 145, 8.2%). Data were analyzed by contingency tables and multiple regression.In total, 456 of 1761 (25.9%) proximal AoRs had redo sternotomy. Aortic redos (redo-AAD and redo-cardiac) had significantly more connective tissue disorders (P .001). On presentation, AAD was least common in aortic redos followed by cardiac redos (redo-cardiac) versus non-redos (5% vs 28% vs 31%, P.001). At reoperation, 190 underwent ascending + hemiarch (21% redo-AAD, 50% redo-aneurysm, 53% redo-cardiac), 140 total arch (64% redo-AAD, 15% redo-aneurysm, 15% redo-cardiac), 110 elephant trunk (52% redo-AAD, 12% redo-aneurysm, 11% redo-cardiac), 159 AVR (36% redo-AAD, 42% redo-aneurysm, 25% redo-cardiac), and 100 aortic root (34% redo-AAD, 22% redo-aneurysm, 10% redo-cardiac). Except for pulmonary, redo sternotomy did not increase risk of postoperative complications. Thirty-day mortality after redo sternotomy was 14%-the greatest among cardiac redos. Over a median follow-up of 13 years, non-redos had significantly greater long-term survival (P .001). Coronary artery disease was a significant predictor of mortality (P .001). After adjustment for coronary artery disease, cardiac redos had the greatest long-term mortality risk (hazard ratio, 1.43, P .005). Previous AoR did not significantly add risk above redo sternotomy alone (P = .734).Redo sternotomy is associated with increased risk for short- and long-term mortality after proximal aortic repair. Despite need for extensive repair, previous proximal aortic (for aneurysm or AAD) repair did not add further risk above that attributable to redo sternotomy.
- Published
- 2020