Background and Aim of the Study: In patients with acute type A aortic
dissection (A-AAD) whether initial repair should include also aortic arch
replacement is still debated. We aimed to assess if extensive aortic repair
prevents from reoperations patients with A-AAD. Methods: Outcomes after
distal reoperation following repair of A-AAD (n = 285; 1977 to 2018) were
analysed in 22 of 226 who underwent ascending aorta/hemiarch replacement (Group
1) and 7 of 59 who had ascending aorta/arch replacement (Group 2).
Results: Distal reoperation was more common in Group 1 (n = 22)
than in Group 2 (n = 0) (p 0.001) while thoracic endovascular
stenting was more frequent in Group 2 (7 vs 3, p 0.001).
Indications for reoperation were pseudoaneurysm at distal anastomosis (n = 4,
18%) and progression of aortic dissection (n = 18, 82%) in Group 1.
Indication for thoracic endovascular stenting was progressive aortic dissection
in 3 patients of Group 1 and in 6 of Group 2. Second reoperation was
required in 2 patients from Group 1 (2%) during a mean follow-up of 5
years. Median follow-up was 4 years in Group 1 and 7 years in Group 2
(p = 0.36). Hospital mortality was 14% in Group 1 and 0% in
Group 2 (p = 0.3). Actuarial survival is 68 10%, and 62
11% for Group 1 and 100% for Group 2 at 5 and 10 years
(p = 0.076). Conclusions: Distal reoperations after A-AAD
repair have an acceptable mortality. An extensive initial repair has lower rate
of reoperation and better mid-term survival and should be indicated especially
for young patients in experienced centers.