Academic Journal
The influence of reoperation on aortic arch reconstructive surgery: Evidence from a multicenter, national registry.
| Τίτλος: | The influence of reoperation on aortic arch reconstructive surgery: Evidence from a multicenter, national registry. |
|---|---|
| Συγγραφείς: | Qin C; Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada; Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Stevens LM; Division of Cardiac Surgery, University of Montreal, Montreal, Québec, Canada., Atoui R; Department of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada., Bittira B; Department of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada., Bozinovski J; Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio., Boodhwani M; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Chia-Ying Chung J; Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Dagenais F; Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Laval, Québec, Canada., Demers P; Division of Cardiac Surgery, Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada., Ei-Hamamsy I; Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Guo M; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Hong J; Department of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada., Lachapelle K; Division of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Laval, Québec, Canada., Moon M; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Ouzounian M; Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Payne D; Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada., Peterson MD; Division of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY., Chu MWA; Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada. Electronic address: michael.chu@lhsc.on.ca. |
| Συλλογικό Έργο: | Canadian Thoracic Aortic Collaborative |
| Πηγή: | The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2026 Aug; Vol. 172 (2), pp. 288-296.e3. Date of Electronic Publication: 2026 Mar 20. |
| Τύπος έκδοσης: | Journal Article; Multicenter Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: St. Louis, MO : Mosby Original Publication: St. Louis. |
| Ιατρικοί όροι (MeSH): | Reoperation*/mortality , Reoperation*/adverse effects , Aorta, Thoracic*/surgery , Blood Vessel Prosthesis Implantation*/adverse effects , Blood Vessel Prosthesis Implantation*/mortality, Postoperative Complications/surgery ; Postoperative Complications/mortality ; Postoperative Complications/epidemiology ; Humans ; Registries ; Female ; Male ; Aged ; Risk Factors ; Middle Aged ; Hospital Mortality ; Treatment Outcome |
| Περίληψη: | Objective: To analyze the in-hospital outcomes of patients undergoing reoperative aortic arch repair and identify risk factors for mortality and morbidity using data from a multicenter, national registry. Methods: We collected data on patients undergoing aortic arch repair (hemiarch or total arch replacement with or without elephant trunk/frozen elephant trunk) under circulatory arrest between 2002 and 2021, including those with acute aortic dissection. Patients with a history of previous open-heart surgery were defined as the redo cases (aortic-redo group and other-redo group). The primary outcomes were operative mortality and a modified Society of Thoracic Surgeons composite end point for mortality and major morbidity (MMOM). The MMOM composite end point was defined as operative mortality, stroke, dialysis-dependent renal failure, deep sternal wound infection, reoperation, and prolonged ventilation >40 hours. Blood transfusion rates were also analyzed. Results: Overall, 374 (15%) of 2481 patients were in the redo cohort. The overall operative mortality of aortic arch reoperations was 12%. Although redo patients had a significantly higher comorbidity burden, no significant difference was identified for the operative mortality among primary, aortic-redo, and other-redo groups (9.3% vs 11% vs 14%; P = .132), and for the MMOM incidence (30% vs 34% vs 39%; P = .075). Additionally, transfusion requirements and intensive care unit/hospital stays were higher in both redo groups (P < .001). To further analyze the redo group, all patients were divided into 4 groups: Primary hemiarch group (n = 1800), primary total-arch group (n = 307), redo hemiarch group (n = 266), and redo total-arch group (n = 108). Operative mortality was significantly higher in the redo hemiarch group (P = .014). In contrast, there was no significant difference in mortality or MMOM between primary and redo total-arch groups (P > .05). Multivariable analyses identified older age, acute aortic dissection, and prolonged cardiopulmonary bypass time (log-transformed) as independent predictors of both operative mortality and MMOM in reoperative arch repair. Conclusions: This study of a national registry demonstrated that selected aortic arch reoperations can be performed with acceptable safety. Older age, acute aortic dissection, and prolonged cardiopulmonary bypass time are associated with worse operative outcomes. Further studies are needed to optimize surgical techniques and perioperative care, in addition to selecting patients who would benefit most from reoperative open arch surgery. (Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Conflict of Interest Statement Dr Chu is supported as the Ray and Margaret Elliott Chair in Surgical Innovation and has received speaker's honoraria from Medtronic, Edwards, Terumo Aortic, and Artivion. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. |
| Contributed Indexing: | Keywords: aortic arch reconstruction; mortality; outcomes; reoperation |
| Entry Date(s): | Date Created: 20260322 Date Completed: 20260731 Latest Revision: 20260731 |
| Update Code: | 20260801 |
| DOI: | 10.1016/j.jtcvs.2026.03.572 |
| PMID: | 41865785 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1097-685X |
|---|---|
| DOI: | 10.1016/j.jtcvs.2026.03.572 |