BACKGROUND: Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 2000, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. MATERIAL AND METHOD: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. RESULT: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperation cases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years. All patients who underwent reoperation survived. Postoperative complications were bleeding and tracheostomy in 1, mediastinitis in 1 and transient delirium in 1 case. Postoperatively, all the patients were followed-up in regular interval. Five patients were evaluated with computerized tomography, 1- 79months(mean: 31.5months) after the reoperation. The false lumen had regressed in 1 cases, persisted without progression in 4 cases. CONCLUSION: The clinical results of reoperation after type A aortic dissection operation were satisfactory. In younger patients with Marfan syndrome, the risk of reoperation was high. Careful and regular follow-up for the persistent false lumen is necessary.
Aneurysm ; Aneurysm, False ; Aorta ; Aorta, Thoracic ; Delirium ; Follow-Up Studies ; Hemorrhage ; Humans ; Marfan Syndrome ; Mediastinitis ; Postoperative Complications ; Recurrence ; Reoperation ; Tracheostomy ; Transplants

BACKGROUND: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. MATERIAL AND METHOD: The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60+/-9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. RESULT: The mean number of grafts was 3.2+/-1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13+/-20 hours after the operation. Mean duration of stay in intensive care unit was 49+/-46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70+/-1.36 pack/patient. CONCLUSIONS: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.
Angina, Stable ; Angina, Unstable ; Arrhythmias, Cardiac ; Arteries ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Delirium ; Diagnosis ; Female ; Femoral Artery ; Gastroepiploic Artery ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Operating Rooms ; Postoperative Complications ; Radial Artery ; Reoperation ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative ; Thromboembolism ; Transplants*