Abstract：
OBJECTIVE: The aim of this study was to analyse the indications, surgical extent and results of treatment, as well as determine the risk factors for adverse outcomes after redo arch surgery.
METHODS: Between January 1996 and December 2022, 120 patients underwent aortic arch reoperations after primary proximal aortic surgery. We retrospectively analysed perioperative data, as well as early and mid-term outcomes in these patients.
RESULTS: Indications for arch reintervention included new aortic aneurysm in 34 patients (28.3%), expanding post-dissection aneurysm in 36 (30.0%), aortic graft infection in 39 (32.5%) and new aortic dissection in 9 cases. Two patients underwent reoperation due to iatrogenic complications. Thirty-one patients (25.8%) had concomitant endocarditis. In-hospital and 30-day mortality rates were 11.7% and 15.0%, respectively. Stroke was observed in 11 (9.2%) and paraplegia in 1 patient. Prior surgery due to aneurysm [odds ratio 4.5; 95% confidence interval (CI) 1.4-17.3] and critical preoperative state (odds ratio 5.9; 95% CI 1.5-23.7) were independent predictors of 30-day mortality. Overall 1- and 5-year survival was 65.8 ± 8.8% and 51.2 ± 10.6%, respectively. Diabetes mellitus (hazard ratio 2.4; 95% CI 1.0-5.1) and peripheral arterial disease (hazard ratio 4.7; 95% CI 1.1-14.3) were independent predictors of late death. The cumulative incidence of reoperations was 12.6% (95% CI 6.7-20.4%) at 5 years. Accounting for mortality as a competing event, connective tissue disorders (subdistribution hazard ratio 4.5; 95% CI 1.6-15.7) and interval between primary and redo surgery (subdistribution hazard ratio 1.04; 95% CI 1.02-1.06) were independent predictors of reoperations after redo arch surgery.
CONCLUSIONS: Despite being technically demanding, aortic arch reoperations are feasible and can be performed with acceptable results.
METHODS: Between January 1996 and December 2022, 120 patients underwent aortic arch reoperations after primary proximal aortic surgery. We retrospectively analysed perioperative data, as well as early and mid-term outcomes in these patients.
RESULTS: Indications for arch reintervention included new aortic aneurysm in 34 patients (28.3%), expanding post-dissection aneurysm in 36 (30.0%), aortic graft infection in 39 (32.5%) and new aortic dissection in 9 cases. Two patients underwent reoperation due to iatrogenic complications. Thirty-one patients (25.8%) had concomitant endocarditis. In-hospital and 30-day mortality rates were 11.7% and 15.0%, respectively. Stroke was observed in 11 (9.2%) and paraplegia in 1 patient. Prior surgery due to aneurysm [odds ratio 4.5; 95% confidence interval (CI) 1.4-17.3] and critical preoperative state (odds ratio 5.9; 95% CI 1.5-23.7) were independent predictors of 30-day mortality. Overall 1- and 5-year survival was 65.8 ± 8.8% and 51.2 ± 10.6%, respectively. Diabetes mellitus (hazard ratio 2.4; 95% CI 1.0-5.1) and peripheral arterial disease (hazard ratio 4.7; 95% CI 1.1-14.3) were independent predictors of late death. The cumulative incidence of reoperations was 12.6% (95% CI 6.7-20.4%) at 5 years. Accounting for mortality as a competing event, connective tissue disorders (subdistribution hazard ratio 4.5; 95% CI 1.6-15.7) and interval between primary and redo surgery (subdistribution hazard ratio 1.04; 95% CI 1.02-1.06) were independent predictors of reoperations after redo arch surgery.
CONCLUSIONS: Despite being technically demanding, aortic arch reoperations are feasible and can be performed with acceptable results.
摘要：
目的：分析适应症，手术范围和治疗结果，以及确定重做足弓手术后不良结局的危险因素。
方法：在1996年1月至2022年12月之间，120例患者在原发性近端主动脉手术后接受了主动脉弓再次手术。我们回顾性分析围手术期资料，以及这些患者的早期和中期结局。
结果：弓部再介入的适应症包括34例患者（28.3%）的新发主动脉瘤，36例（30.0％）扩大的夹层后动脉瘤，主动脉移植物感染39例（32.5%），新发主动脉夹层9例。由于医源性并发症，两名患者接受了再次手术。31例患者（25.8％）合并心内膜炎。住院和30天死亡率分别为11.7%和15.0%,分别。11例（9.2％）患者出现中风，1例患者出现截瘫。术前动脉瘤(OR4.5;95%CI1.4-17.3)和术前危重状态(OR5.9;95%CI1.5-23.7)是30天死亡率的独立预测因子。1年和5年总生存率为65.8±8.8％，和51.2±10.6%。糖尿病(HR2.4;95%CI1.0-5.1)和外周动脉疾病(HR4.7;95%CI1.1-14.3)是晚期死亡的独立预测因子。5年再次手术的累积发生率为12.6%(95%CI6.7-20.4%)。将死亡率视为竞争事件，结缔组织疾病(SHR4.5;95%CI1.6-15.7)和初次手术与重做手术间隔时间(SHR1.04;95%CI1.02-1.06)是重做足弓手术后再次手术的独立预测因子。
结论：尽管技术要求很高，主动脉弓再次手术是可行的，并且可以获得可接受的结果。
方法：在1996年1月至2022年12月之间，120例患者在原发性近端主动脉手术后接受了主动脉弓再次手术。我们回顾性分析围手术期资料，以及这些患者的早期和中期结局。
结果：弓部再介入的适应症包括34例患者（28.3%）的新发主动脉瘤，36例（30.0％）扩大的夹层后动脉瘤，主动脉移植物感染39例（32.5%），新发主动脉夹层9例。由于医源性并发症，两名患者接受了再次手术。31例患者（25.8％）合并心内膜炎。住院和30天死亡率分别为11.7%和15.0%,分别。11例（9.2％）患者出现中风，1例患者出现截瘫。术前动脉瘤(OR4.5;95%CI1.4-17.3)和术前危重状态(OR5.9;95%CI1.5-23.7)是30天死亡率的独立预测因子。1年和5年总生存率为65.8±8.8％，和51.2±10.6%。糖尿病(HR2.4;95%CI1.0-5.1)和外周动脉疾病(HR4.7;95%CI1.1-14.3)是晚期死亡的独立预测因子。5年再次手术的累积发生率为12.6%(95%CI6.7-20.4%)。将死亡率视为竞争事件，结缔组织疾病(SHR4.5;95%CI1.6-15.7)和初次手术与重做手术间隔时间(SHR1.04;95%CI1.02-1.06)是重做足弓手术后再次手术的独立预测因子。
结论：尽管技术要求很高，主动脉弓再次手术是可行的，并且可以获得可接受的结果。
