Limited aortic root repair for acute type A dissection is associated with greater risk of proximal reoperations compared to full aortic root replacement. Surgical outcomes for patients undergoing reoperative root replacement after previous dissection repair are unknown. This study seeks to determine outcomes for these patients to further inform the debate surrounding optimal upfront management of the aortic root in acute dissection. Retrospective record review of all patients who underwent full aortic root replacement after a previous type A dissection repair operation at a tertiary academic referral center from 2004-2020 was performed. Among 57 cases of reoperative root replacement after type A repair, 35 cases included concomitant aortic arch replacements, and 21 cases involved coronary reconstruction (unilateral or bilateral modified Cabrol grafts). There were 3 acute post-operative strokes and 4 operative mortalities (composite 30-day and in-hospital deaths, 7.0%) . Mid-term outcomes were equivalent for patients who required arch replacement compared to isolated proximal repairs (81.8% vs. 80.6% estimated 5-year survival, median follow-up 5.53 years. Reoperative root replacement after index type A dissection repairs, including those with concomitant aortic arch replacement and/or coronary reconstruction is achievable with acceptable outcomes at an experienced aortic center.

与完全主动脉根置换相比，急性 A 型夹层的有限主动脉根修复与近端再次手术的风险更大相关。在先前的夹层修复后接受再手术牙根置换的患者的手术结果未知。本研究旨在确定这些患者的结局，以进一步了解围绕急性夹层主动脉根部最佳前期管理的争论。对 2004 年至 2020 年在三级学术转诊中心接受过 A 型夹层修复手术后接受全主动脉根部置换术的所有患者进行了回顾性记录审查。57 例 A 型修复术后再次根部置换术，其中 35 例合并主动脉弓置换术，21例涉及冠状动脉重建（单侧或双侧改良Cabrol移植物）。有 3 例术后急性中风和 4 例手术死亡（复合 30 天和住院死亡，7.0%）。与孤立的近端修复相比，需要牙弓置换的患者的中期结果相当 (81.8%对比80.6% 的估计 5 年生存期，中位随访 5.53 年。在指数 A 型夹层修复后再次手术根部置换，包括伴随主动脉弓置换和/或冠状动脉重建的那些，在经验丰富的主动脉中心可以实现可接受的结果。