{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T11:07:44Z","timestamp":1782126464499,"version":"3.54.5"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,10,11]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">All aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30\u2010day or in\u2010hospital mortality. Secondary outcomes included organ\u2010specific morbidity and 1\u2010 and 5\u2010year outcomes as estimated using the Kaplan\u2013Meier method. The majority of initial reoperations were proximal aortic (aortic valve, aortic root, or ascending) or aortic arch procedures (62.5%, n=55); most initial reoperations were performed in the elective setting (83.1%, n=74). Additional nonstaged second or more reoperations were required in 21 patients (23.6%) after the initial reoperation, during a median follow\u2010up of 2.5\u00a0years after the initial reoperation. Thirty\u2010day or in\u2010hospital mortality for all reoperations was 7.0% (elective: 6.3%; nonelective: 11.1%) with acceptable rates of organ\u2010specific morbidity, given the procedural complexity. One\u2010 and 5\u2010year overall survival after initial reoperation was 85.9% and 64.9%, respectively, with aorta\u2010specific survival of 88% at 5\u00a0years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Reoperation after acute type A aortic dissection repair is associated with low rates of mortality and morbidity. These data support more limited index repair for acute type A dissection, especially for patients undergoing index repair in lower volume\u00a0centers without expertise in extensive repair, because reoperations, if needed, can be performed safely in referral aortic centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.117.006376","type":"journal-article","created":{"date-parts":[[2017,10,3]],"date-time":"2017-10-03T20:11:20Z","timestamp":1507061480000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy"],"prefix":"10.1161","volume":"6","author":[{"given":"Hanghang","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Wagner","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehsan","family":"Benrashid","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Keenan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ranney","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babatunde","family":"Yerokun","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey G.","family":"Gaca","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L.","family":"McCann","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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