Discussion
Our case report describes the treatment of ruptured aortic root aneurysm by the replacement of the aortic arch by vascular prosthesis with reimplantation of CABG proximal anastomoses. Type A aortic dissection is a life-treating situation with high associated mortality [1]. Open surgical aortic repair is a typical option for aortic dissection treatment. In modern surgical practice, hemiarch is a safe and effective procedure, especially in high-volume cardiac centers with sufficient experience [2]. If the patient previously underwent other cardiac surgery procedures, it increases risks because of resternotomy and altered mediastinum. There are a few case reports and small researches in the medical literature about the outcomes of aortic dissection in patients with previous cardiac surgery (PCS) [3-6]. Gillinov et al. after analysis of 56 patients with a history of previous cardiac surgery postulated that patients having type A dissection late after cardiac surgery infrequently have cardiac tamponade and hemodynamic collapse; they require coronary angiography. Authors underlined that postoperative mortality is low on condition of sufficient preoperative diagnostics and perioperative critical care [7]. Norton et al. found that despite the patients with PCS usually having significantly more comorbidities and the operation being more complicated, the perioperative outcomes, including mortality, were comparable to those of patients with primary operation. The long-term survival was significantly worse in patients with previous surgery; however, this circumstance was not a risk factor for operative mortality (OR= 1.6, p=0.36) or all-time mortality (HR=1.3, p=0.33) [3]. Özçınar et al. confirm this conclusion: after analysis of the medical history of 32 patients with aortic type A dissection after PCS, they found that careful planning of perioperative tactic provides results that are comparable with outcomes in patients without PCS [8]. Sandhu et al. analyzed 456 redo sternotomy cases in proximal aortic repair and found that resternotomy is associated with increased risk for short- and long-term mortality, but the fact of PCS (aortic) did not add further risk [9]. For patients with high risk, hybrid operations can be an option [10,11].
Our patient underwent open surgery by redo sternotomy, which increased risks. Authors strongly believe that scrupulous perioperative critical care and diagnostics can dramatically reduce risks and improve postoperative outcomes.
Conflict of interestsThe authors declare that there are no conflicts of interests.
Ethics statementEthics approval was not necessary, written and informed consent was obtained from the patient. Written consent for publication of case and images was obtained from the patient