{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:03:36Z","timestamp":1753877016076,"version":"3.41.2"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T00:00:00Z","timestamp":1714435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Aortic arch or aortic root replacement is not performed in all cases of acute type A aortic dissection (ATAD), and a second aortic procedure will become necessary over time for some patients. Indications and outcomes, of second aortic procedures have not been studied extensively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Characteristics and in-hospital outcomes of all patients undergoing surgical repair for type A acute aortic dissection were analysed and patients needing second aortic procedure during follow-up were identified. The latter group was divided in 2 subgroups: on-pump includes patients operated on using cardiopulmonary bypass and off-pump without cardiopulmonary bypass.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>A total of 638 patients underwent surgery for ATAD; 8% required a second aortic procedure. The most frequent indication for the second aortic procedure was dehiscence of suture lines (44%), followed by arch dilatation (24%). In-hospital mortality was 12%. Isolated ascending aorta replacement at the first surgery was associated with higher incidence of second aortic procedure (P\u2009=\u20090.006). Most patients in the on-pump group underwent a proximal reoperation (75%), with a mortality rate of 14.2%. In-hospital mortality of patients in the off-pump group was 7.7%. Long-term survival analysis showed no difference between groups (P\u2009=\u20090,526), Off-pump patients have greater likelihood of a second intervention during follow-up (P \u2009=\u20090.004).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Extended aortic root surgery and customized aortic arch repair in ATAD could be reasonable to reduce the incidence and mortality of high-risk second aortic procedures.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivae076","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T23:19:06Z","timestamp":1714519146000},"source":"Crossref","is-referenced-by-count":0,"title":["Indications and outcomes of second aortic procedures after acute type A dissection repair"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9529-7094","authenticated-orcid":false,"given":"Mohammed","family":"Morjan","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Z\u00fcrich , Z\u00fcrich, Switzerland"},{"name":"Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty , Duesseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos-A","family":"Mestres","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Z\u00fcrich , Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8335-5517","authenticated-orcid":false,"given":"Vedran","family":"Savic","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Z\u00fcrich , Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6751-4650","authenticated-orcid":false,"given":"Mustafa","family":"Ger\u00e7ek","sequence":"additional","affiliation":[{"name":"Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg , Duisburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-757X","authenticated-orcid":false,"given":"Mathias","family":"Van Hemelrijck","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Z\u00fcrich , Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-7733","authenticated-orcid":false,"given":"Juri","family":"Sromicki","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Z\u00fcrich , Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omer","family":"Dzemali","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Z\u00fcrich , Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Reser","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Z\u00fcrich , Z\u00fcrich, Switzerland"},{"name":"Herzklinik Hirslanden , Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"2024051403544971800_ivae076-B1","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.jacc.2015.05.029","article-title":"Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection","volume":"66","author":"Pape","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2024051403544971800_ivae076-B2","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1016\/j.jacc.2011.06.067","article-title":"Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection","volume":"58","author":"Bonser","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2024051403544971800_ivae076-B3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S0140-6736(08)60994-0","article-title":"Acute aortic dissection","volume":"372","author":"Golledge","year":"2008","journal-title":"Lancet"},{"key":"2024051403544971800_ivae076-B4","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. 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