Redo total arch replacement with frozen elephant trunk for patients with previous proximal aortic replacement for acute type A dissection

Objectives: The extent of arch replacement for aortic dissection remains controversial. The natural history of a residually dissected arch remains unknown, and the morbidity of arch reintervention in these settings is understudied. Therefore, the aim of this study was to investigate outcomes of redo total arch replacement in patients who had previous proximal aortic repair for acute type A dissection. Methods: In total, 79 consecutive patients underwent redo total arch replacement with frozen elephant trunk after previous type A dissection repair. Surgical outcomes were obtained from the institutional database and the electronic medical record was reviewed for follow-up outcomes. Results: The median time between type A repair and redo total arch replacement with frozen elephant trunk was 4.25 [2.05, 7.78] years. The most common comorbidity was hypertension in 76 of 79 (96.2%), and 14 of 79 (17.7%) had previous cerebrovascular disease. The median crossclamp and circulatory arrest times (minutes) were 78 [61, 108] and 18 [14, 25], respectively. The operative mortality rate was 3 in 79 (3.8%), the postoperative stroke rate was 7 of in (8.9%), and the paraplegia rate was 4 in 79 (5.1%). The 1-year survival was 93.5% (88.1%-99.2%), and the 3-year cumulative incidence of aortic reintervention was 53.1% (38.3%-65.8%). In total, 35 patients required distal aortic reintervention, including 19 distal thoracic endovascular aortic repair extensions, and 5 open thoracoabdominal aneurysm repairs. Conclusions: Redo total arch replacement after previous proximal aortic repair for acute type A dissection can be performed safely at an experienced aortic referral center.