Comparable Outcomes in Redo Total Arch Replacement for Previous Aortic Dissection vs. Other Cardiac Surgeries: A Single-Center Pilot Study of the E-Vita Open Hybrid Prosthesis

TL;DR

This study found similar outcomes for redo aortic surgery in patients with previous aortic dissection and those with other heart surgeries.

Contribution

Preliminary evidence that previous aortic dissection does not increase surgical risk in redo total arch replacement.

Findings

In-hospital mortality and stroke rates were similar between the two patient groups.

Survival rates at 1, 2, and 3 years were comparable for both groups.

The study highlights the need for larger studies due to its small sample size.

Abstract

Background/Objectives: Total arch replacement (TAR) with frozen elephant trunk (FET) using the E-vita Open hybrid prosthesis represents a complex surgical intervention for extensive aortic pathologies in previously operated patients. The comparative safety profile between patients with previous acute Type A dissection repair versus other cardiac surgical histories remains unclear. This pilot study evaluated early and midterm outcomes to determine whether previous aortic dissection carries additional operative risk compared to other previous cardiac operations. Methods: This retrospective single-center pilot cohort study analyzed 27 patients who underwent TAR with E-vita Open hybrid prosthesis between January 2013 and June 2024. Patients were stratified into two groups: Group 1 comprised patients with previous acute Type A dissection repair (n = 15, 55.6%), and Group 2 included patients with other previous cardiac operations (n = 12, 44.4%). Primary endpoints were in-hospital mortality and survival at 1, 2, and 3 years. Secondary endpoints included major neurological complications, spinal cord injury, reoperation for bleeding, and freedom from aortic reinterventions. Results: Baseline characteristics demonstrated comparable risk profiles between groups, with similar EuroSCORE II values (median 4.55 [IQR 3.86–7.28] vs. 5.41 [IQR 3.93–6.74], p = 1.0). Despite Group 1 showing trends toward longer operative times (580.07 ± 126.84 vs. 481.25 ± 119.29 min, p = 0.053), major postoperative outcomes were statistically equivalent. In-hospital mortality was 6.7% in Group 1 versus 0% in Group 2 (p = 1.0). Stroke rates were comparable (20.0% vs. 25.0%, p = 1.0), as were paraplegia rates (13.3% vs. 8.3%, p = 1.0) and dialysis requirements (46.7% vs. 41.7%, p = 0.334). Survival rates at 1, 2, and 3 years were 80.0%, 66.7%, and 60.0% for Group 1 and 75.0%, 66.7%, and 50.0% for Group 2, respectively (all p > 0.05). Conclusions: This pilot study suggests preliminary evidence of comparable early and midterm outcomes between patients with previous Type A dissection repair and those with other previous cardiac operations when undergoing TAR with E-vita Open hybrid prosthesis at an experienced center. However, the small sample size limits definitive conclusions and highlights the need for larger multicenter studies to confirm these findings.

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