Objective To investigate the impact of prior cardiac surgery (PCS) on outcomes following Acute Type A Aortic Dissection (ATAAD) repair at a high-volume, aortic center. Methods This was a retrospective analysis including all ATAAD repairs from July 1997 to October 2024. Multivariable regression analysis (MVA) assessed independent association with primary and secondary outcomes. The primary outcome was the composite of in-hospital major adverse events (MAEs), including operative mortality (OM), myocardial infarction (MI), cerebrovascular accident (CVA), tracheostomy, renal failure and re-exploration for bleeding. The secondary outcome was all-cause mortality over follow-up. Results In total, 413 patients were included; 17.4%(72/413) had PCS. The PCS cohort had a greater comorbid burden than the first cardiac surgery (FCS) cohort, including increased incidence of prior MI (36.1%[26/72] vs. 11.4%[39/341], p<0.001), prior CVA (34.7%[25/72] vs. 15.8%[54/341], p<0.001) and renal disease (48.6%[35/72] vs. 26.4%[90/341], p<0.001). The incidence of MAE was higher in the PCS cohort (26.4%[19/72] vs 15.5%[53/341]; p=0.042) as was OM (11.1%[8/72] vs 3.5%[12/341], p=0.015). At median follow-up 6.6 years (95% Confidence Interval [CI] 5.2-8.5 years), the PCS cohort had lower survival (45.2% [95%CI:33-61.9%] vs. 71% [95%CI:65.2-77.3%]). On MVA, PCS was not associated with increased risk of MAEs (Odds Ratio 1.16[95%CI:0.58-2.24], p=0.68) but was associated with increased risk of all-cause mortality over follow-up (Hazard Ratio 1.69[95%CI:1.15-2.49], p=0.008). Conclusions Prior cardiac surgery was not independently associated with increased risk of MAE following ATAAD repair. However, the PCS cohort exhibited greater comorbidity burden than the FCS, contributing to their increased morbidity and mortality postoperatively.

BACKGROUND:This study aimed to evaluate the impact of proximal vs distal aortic clamping during thoracoabdominal aortic aneurysm (TAAA) repair, with a focus on the incidence and predictors of left recurrent laryngeal nerve (LRN) injury, and by assessing associations with respiratory morbidity, neurologic complications, and long-term survival. METHODS:A retrospective analysis was performed on 555 patients who underwent open Crawford extent I or II TAAA repair between 1997 and 2025. Patients were stratified by clamp location relative to the left subclavian artery. Operative data, early outcomes, and long-term survival were compared. Multivariable logistic regression was used to identify predictors of LRN injury and respiratory complications. RESULTS:Of the 555 patients, 142 (25.6%) underwent Crawford extent II repairs. Patients who had proximal clamps were younger and more likely male, and they had higher rates of previous sternotomy. They required more frequent left subclavian artery bypass, had longer clamp times, and had more frequent use of partial bypass and intercostal artery reimplantation. The overall LRN injury rate was 26 of 555 patients (4.7%), significantly higher in the proximal clamp group (odds ratio [OR], 4.68; 95% CI, 2.00-11.43; P < .001). Chronic obstructive pulmonary disease was also an independent predictor (OR, 3.48; 95% CI, 1.38-9.07; P = .009). LRN injury was not associated with increased respiratory complications (OR, 1.01; 95% CI, 0.59-1.69; P = .977). Operative mortality, neurologic deficit, and spinal cord ischemia rates were similar between the groups. Long-term survival at 10 years was 88.0%, with no significant difference between the clamp groups. CONCLUSIONS:Proximal aortic clamping during TAAA repair is associated with a higher risk of LRN injury, but it does not increase respiratory morbidity or neurologic complications or affect long-term survival.

Objective To investigate the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and outcomes following cardiovascular surgery with deep hypothermic circulatory arrest (DHCA). Methods This was a retrospective analysis. All procedures with DHCA from July 1997 to January 2025 were included. Maximally selected rank statistics identified the optimal NLR cutoff. This NLR cutoff was used for comparisons between high- and low-NLR cohorts. Multivariable regression (MVA) assessed independent association with outcomes. NLR was evaluated as a continuous variable in MVA to assess association irrespective of derived cutoff. The primary outcome was the composite of in-hospital major adverse events (MAEs), consisting of: operative mortality (OM), myocardial infarction, cerebrovascular accident, re-exploration for bleeding, tracheostomy and new postoperative dialysis. The secondary outcome was all-cause mortality. Results Analysis included 1335 patients, with 16.7%(223/1335) in the high-NLR cohort (≥6.22). The high-NLR cohort had increased incidence of smoking (62.8%[140/223] vs. 52.1%[579/1112], p=0.004), chronic obstructive pulmonary disease (26.9%[60/223] vs. 14.1%[157/1112], p<0.001), peripheral vascular disease (11.7%[26/223] vs. 7.3%[81/1112], p=0.04) and renal disease (37.2%[83/223] vs. 12.3%[137/1112], p<0.001). The incidence of MAE was higher in the high-NLR cohort (11.7%[26/223] vs. 5.8%[64/1112], p=0.002). Median follow-up was 10.6 years (95% Confidence Interval [CI]:9.9-11.6). Ten-year survival was lower in high-NLR cohort (52.7%[95%CI:46-60.5] vs.71.3%[95%CI:68.2-74.5]). On MVA, NLR was associated with increased risk of MAE (Odds Ratio 1.04 [95%CI:1.00-1.07], p=0.02) and all-cause mortality (Hazard Ratio 1.03 [95%CI:1.02-1.05], p<0.001). Conclusion Preoperative NLR was associated with increased risk of morbidity and all-cause mortality, independent of comorbidities, following cardiovascular surgery with DHCA.

Objective: To investigate the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and outcomes following cardiovascular surgery with deep hypothermic circulatory arrest (DHCA). Methods: This was a retrospective analysis. All cardiovascular surgical procedures with DHCA between July 1997 and January 2025 were included. Maximally selected rank statistics identified the optimal NLR cutoff. This NLR cutoff was used for comparisons between high-NLR and low-NLR cohorts. Multivariable regression analysis assessed independent associations with outcomes. NLR was evaluated as a continuous variable to assess associations irrespective of derived cutoff. The primary outcome was the composite of in-hospital major adverse events (MAE), consisting of operative mortality, myocardial infarction, cerebrovascular accident, reexploration for bleeding, tracheostomy, and new postoperative dialysis. The secondary outcome was all-cause mortality. Results: Our analysis included 1335 patients, with 16.7% (223/1335) in the high-NLR cohort (≥6.22). The high-NLR cohort had increased incidence of smoking (62.8% [140/223] vs 52.1% [579/1112]; P = .004), chronic obstructive pulmonary disease (26.9% [60/223] vs 14.1% [157/1112]; P < .001), peripheral vascular disease (11.7% [26/223] vs 7.3% [81/1112]; P = .04), and renal disease (37.2% [83/223] vs 12.3% [137/1112]; P < .001). The incidence of MAE was higher in the high-NLR cohort (11.7% [26/223] vs 5.8% [64/1112]; P = .002). Median follow-up was 10.6 years (95% confidence interval [CI], 9.9-11.6 years). Ten-year survival was lower in high-NLR cohort (52.7% [95% CI, 46%-60.5%] vs 71.3% [95% CI, 68.2%-74.5%]). On multivariate analysis, NLR was associated with increased risk of MAE (odds ratio, 1.04; 95% CI, 1.00-1.07; P = .02) and all-cause mortality (hazrd ratio, 1.03; 95% CI, 1.02-1.05; P < .001). Conclusions: Preoperative NLR was associated with increased risk of morbidity and all-cause mortality independent of comorbidities following cardiovascular surgery with DHCA.

OBJECTIVES:This study aimed to compare operative outcomes between patients undergoing thoraco-abdominal aortic aneurysm (TAAA) repair for degenerative disease and chronic dissected aneurysm. METHODS:A retrospective analysis was conducted on consecutive patients who underwent elective TAAA repair for chronic dissection or degenerative disease between 1997 and 2025. The primary outcome measure was operative mortality, while secondary outcomes included major adverse events (MAE). Factors associated with mortality or MAE were identified using multivariable analysis. RESULTS:A total of 734 patients underwent open TAAA repair, with 339 (46%) having atherosclerotic disease and 395 (54%) having chronic dissection. The degenerative disease group was characterized by older age (71.2 ± 10.2vs.58.9 ± 13.7, P < .001), higher comorbidity burden (such as ischaemic heart disease, pulmonary disease, diabetes, and renal impairment), and lower rates of connective tissue disorders (2.4%vs 26.1%, P < .001), and Extent I or II TAAA (57.5% vs 84.3%, P < .001). The overall operative mortality rate for the entire cohort was 5.9% and was higher in the chronic dissection group [OR, 2.54 (1.15-5.69), P = .022]. Incidence of paraplegia (either immediate or delayed) was higher in the degenerative group (2.8% vs. 0.8%, P = .028). Both groups had a similar risk of MAE [OR, 1.49 (0.90-2.45), P = .119]. Factors that were associated with MAE included older age [OR, 1.02 (1.00-1.04), P = .050], preoperative renal impairment [OR, 1.83 (1.17-2.85), P = .007], Extent I or II TAAA [OR, 1.76 (1.17-2.65), P = .007], and lower preoperative FEV1 [OR, 0.97 (0.95-0.99), P = .001]. CONCLUSIONS:Chronic dissection aetiology was associated with higher adjusted operative mortality following open TAAA repair, likely reflecting greater anatomical complexity, with similar risk of MAE.

ObjectiveTo describe the clinical characteristics, operative data, and outcomes of total aortic arch replacement (TAR) performed at a high-volume aortic dedicated center, with a focus on technical aspects and neurologic protection.MethodsWe conducted a retrospective analysis of 536 consecutive patients who underwent TAR between 1997 and 2025. Data were collected from a prospectively maintained institutional database. All procedures were performed via median sternotomy with deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) for neuroprotection. Arch reconstruction was performed using either island or debranching techniques, based on patient anatomy and comorbidities. Multivariable Cox regression analysis was used to identify predictors of 10-year mortality.ResultsThe mean patient age was 66.9 ± 12.9 years; 41% were female and 36.8% underwent redo operations. The mean cardiopulmonary bypass time was 158.1 ± 34.7 min, cardiac ischemic time was 102.8 ± 40.7 min, and mean circulatory arrest time was 40 ± 12.8 min. Concomitant procedures were performed in 49.6% of patients. Operative mortality was 2.1%, stroke occurred in 2.6%, and renal complications occurred in 3.2%. The 10-year survival rate was 80.7%. Multivariable analysis identified pulmonary disease, renal impairment, larger aneurysm size, and urgent/emergent presentation as independent predictors of late mortality. The use of RCP provided effective cerebral protection across a wide range of operative complexity.ConclusionTotal aortic arch replacement can be performed with low mortality and excellent long-term outcomes using DHCA with RCP. A tailored operative approach and institutional experience are key to optimizing outcomes.

INTRODUCTION:To investigate the relationship between preoperative subclinical inflammation, quantified by the neutrophil-to-lymphocyte ratio (NLR), and postoperative outcomes following open thoracoabdominal aortic aneurysm repair (TAAAr). METHODS:This was a retrospective analysis from a single high-volume aortic center using the institutional aortic database. All patients who underwent TAAAr between 1997 and 2024 and had preoperative testing needed for NLR calculation were eligible. Maximally selected rank statistics were utilized to identify optimal NLR cutoff. Multivariable regression analysis, adjusted for key prognostic and surgical variables, was used to identify association. The primary outcome was cumulative mortality. The key secondary outcome was the composite incidence of in-hospital major adverse events (MAEs), including operative mortality (mortality prior to discharge), renal dysfunction, myocardial infarction, cerebrovascular accident, reintervention for hemorrhage, need for tracheostomy, and gastrointestinal complications. RESULTS:A total of 591 patients were included. Operative mortality was low across the entire cohort (3.7% [22/591]). At median follow-up 84.0 ± 3.5 mo, the high-NLR (≥ 2.36) cohort (417/591) had higher cumulative mortality (40.3% [168/417] versus 25.9% [45/174], P = 0.001) compared to the low-NLR (<2.36) cohort. The high-NLR cohort also had increased incidence of MAEs (18.9% [79/417] versus 11.5% [20/174], P = 0.037). On multivariable analysis, NLR was independently associated with cumulative mortality (hazard ratio 1.05 95% confidence interval [1.01, 1.08], P = 0.01) and MAEs (odds ratio 1.07 95% confidence interval [1.01, 1.13], P = 0.027). CONCLUSIONS:NLR was independently associated with cumulative mortality and MAEs after TAAAr. NLR may provide a novel metric for risk stratification in this high-risk patient cohort.

OBJECTIVE:To assess outcomes after aortic root replacement with Bentall procedure for aortic aneurysm, dissection, and endocarditis. METHODS:We identified consecutive patients undergoing Bentall procedures from 1997 to 2023, with stratification based on the primary diagnosis. Operative outcomes and long-term survival were compared. RESULTS:Of 1493 patients, 1378 (92.3%) underwent surgery for aneurysms, 75 (5%) for dissections, and 40 (2.7%) for endocarditis. The aneurysm group was older (61 years [range, 50-70 years] vs 57 years [range, 47-66.5 years] vs 56 years [range, 49-64 years]; P = .024). Patients with dissection or endocarditis had more preoperative myocardial infarctions (7.4% vs 12% vs 17.5%; P = .026), cerebrovascular accidents (9.6% vs 18.7% vs 45%; P < .001), renal dysfunction (8.3% vs 22.7% vs 45%; P < .001), shock (0.1% vs 10.7% vs 15%; P < .001), and ruptures (0.4% vs 10.7% vs 10%; P < .001). Regarding outcomes, acute renal failure (0.6% vs 1.3% vs 7.5%; P < .001) and operative mortality (0.4% vs 1.3% vs 7.5%; P = .001) were higher for endocarditis. Reexploration for bleeding was highest for dissections (4.1% vs 12% vs 2.5%; P = .004). Ten-year survival was similar between groups (71.8% vs 67% vs 83.7%; P = .94), with mean follow-up 68.2 ± 2.08 months. Multivariable analysis found age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.05; P < .001), chronic obstructive pulmonary disease (HR, 2.12; 95% CI, 1.44-3.11; P < .001), renal dysfunction (HR, 1.97; 95% CI, 1.4-2.78; P < .001), and ejection fraction (HR, 0.97; 95% CI, 0.95-0.98; P < .001) were associated with late mortality but primary diagnosis was not. CONCLUSIONS:The Bentall procedure can be performed with low operative risk for aneurysms and selected dissections. Endocarditis is associated with higher but acceptable operative mortality. Excellent long-term survival can be expected after surviving initial operative risk.

OBJECTIVES:Evaluate the impact of coronary artery bypass grafting (CABG) on outcomes in patients undergoing aortic root replacement (ARR). METHODS:This was a retrospective cohort study of patients undergoing elective ARR at a single high-volume centre. Patients were stratified based on whether they underwent concomitant CABG, and outcomes were compared using multivariable regression and survival analysis. RESULTS:A total of 1518 patients (87.2%) underwent isolated ARR, while 223 (12.8%) underwent ARR with CABG. A majority (N = 205, 91.9%) of CABG procedures were elective. In 18 patients (8.1%), CABG was needed emergently. Patients requiring CABG were older (64.8 ± 9.8 vs 55.1 ± 14.5 years, P < .001) with a greater incidence of comorbidities. Female sex (OR 4.54 [1.57-12.62], P = .004) and smaller aortic root size (OR 0.34 [0.16-0.75], P = .007) were associated with need for emergency CABG on multivariable analysis. Operative mortality (OM) was significantly higher in all patients needing concomitant CABG (1.8% vs 0.2%; OR 6.08 [1.16-35.3], P = .032). Among those needing CABG, emergency CABG patients had a higher OM than elective CABG (11.1% vs 1%; OR 12.5 [1.45-100], P = .014). Respiratory complications were more common after emergency CABG as was the incidence of postoperative renal dysfunction and a composite of major adverse events. 10-year survival for all patients requiring CABG was not significantly compromised (73.8% vs 86.2%; HR 0.98 (0.6-1.59), P = .937). CONCLUSIONS:Elective and emergency CABG increase operative risk but do not reduce long-term survival in patients undergoing ARR. Females and those with small aortic roots are at particular risk for needing emergency CABG.

Reoperative total arch replacement (TAR) following prior cardiovascular surgery presents significant technical challenges and is associated with higher risk profiles. With increasing numbers of patients undergoing reoperation as a result of successful outcomes from primary procedures, we sought to compare the clinical outcomes of reoperative TAR with those of first-time TAR. We reviewed 474 patients who underwent TAR at our institution from 1997 to 2024. Of these, 171 patients (36%) had previously undergone cardiovascular surgery, while the remaining 303 (64%) were undergoing TAR for the first time. Demographic, procedural, and outcome data were collected and analyzed. Comparisons between the reoperative and primary groups were made, and multivariable regression was used to identify covariates associated with major postoperative adverse events (MAEs). Patients in the reoperative group were younger on average (61.5 ± 13.5 vs 70.7 ± 10.9 years, P < 0.001), but presented with a higher burden of comorbidities, including ischemic heart disease (15.8% vs 7.3%, P = 0.006), prior strokes (38.6% vs 15.5%, P < 0.001), and renal impairment (24.6% vs 12.5%, P = 0.001). Operative times were significantly longer for reop TAR, with extended circulatory arrest (48.4 ± 12.8 vs 36 ± 10.8 minutes, P < 0.001), cardiac ischemia (118.2 ± 44.2 vs 99 ± 32.1 minutes, P < 0.001), and cardiopulmonary bypass duration (180.7 ± 38.2 vs 146.7 ± 26.3 minutes, P < 0.001). The reoperative group had higher operative mortality (4.1% vs 0.3%, P = 0.007) and a 2.3-fold increased risk of MAEs (OR 2.27, 95% CI 1.01-5.1, P = 0.046). Reoperative TAR is associated with increased operative risk, longer procedural times, and higher rates of operative complications compared to first-time TAR. Despite these challenges, successful outcomes can be achieved with thorough preoperative planning and attention to key technical details.

OBJECTIVE:To assess long-term survival and operative outcomes of open descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair at a high-volume center. METHODS:We identified all consecutive patients undergoing DTA/TAAA repair between 1997 and 2023 and stratified based on aneurysm extent. Operative outcomes were assessed by univariable and multivariable analysis. Long-term survival was estimated by Kaplan-Meier method. RESULTS:Of 1020 patients, 273 had DTA and 747 had TAAA (53.1% extent I, 18.5% extent II, 20.2% extent III, 7.6% extent IV, and 5% extent V). Operative mortality (OM) was 4.6% overall, 5.1% in the DTA group, and 4.4% in the TAAA group. The incidence of myocardial infarction was 0.5%; stroke, 1.8%; tracheostomy, 6.9%; dialysis, 4.8%; and paraplegia, 1.3%. On multivariable analysis, diabetes (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.20-5.13; P = .014) and renal insufficiency (OR, 3.17; 95% CI, 1.63-6.13; P < .001) were associated with OM. In the TAAA group, extent II aneurysm (OR, 3.56; 95% CI, 1.59-7.96; P = .002) was associated with OM. The median follow-up was 6.72 (95% CI, 5.73-7.81) years. Five- and 10-year survival were 67.2% and 48.2% for the DTA group and 69.9% and 47.5% for the TAAA group. In the TAAA group, 5- and 10-year survival were 76.4% and 49.4% for extent I, 62.5% and 43.3% for extent II, 60.1% and 45.6% for extent III, and 72.6% and 47.4% for extent IV. Age (hazard ratio [HR], 1.04; 95% CI, 1.02-1.05; P < .001), chronic obstructive pulmonary disease (HR, 1.55; 95% CI, 1.25-1.92; P < .001), diabetes (HR, 1.5; 95% CI, 1.09-2.07; P = .013), renal insufficiency (HR, 1.47; 95% CI, 1.18-1.85; P < .001), shock (HR, 1.83; 95% CI, 1.19-2.81; P = .006), and urgent/emergent surgery (HR, 1.27; 95% CI, 1.03-1.58; P = .027) were associated with long-term mortality. CONCLUSIONS:At experienced centers, operative outcomes and long-term survival after open DTA/TAAA repair are encouraging. Short-term outcomes are dependent on preoperative risk factors and aneurysm extent, while long-term survival is dependent on age and chronic comorbidities.

Background Imaging is vital for assessing rectal cancer, with endoanal ultrasound (EAUS) being highly accurate in large tertiary medical centers. However, EAUS accuracy drops outside such settings, possibly due to varied examiner experience and fewer examinations. This underscores the need for an AI-based system to enhance accuracy in non-specialized centers. This study aimed to develop and validate deep learning (DL) models to differentiate rectal cancer in standard EAUS images.Methods A transfer learning approach with fine-tuned DL architectures was employed, utilizing a dataset of 294 images. The performance of DL models was assessed through a tenfold cross-validation.Results The DL diagnostics model exhibited a sensitivity and accuracy of 0.78 each. In the identification phase, the automatic diagnostic platform achieved an area under the curve performance of 0.85 for diagnosing rectal cancer.Conclusions This research demonstrates the potential of DL models in enhancing rectal cancer detection during EAUS, especially in settings with lower examiner experience. The achieved sensitivity and accuracy suggest the viability of incorporating AI support for improved diagnostic outcomes in non-specialized medical centers.

BACKGROUND:We compared the outcomes of aortic root replacement by composite valve grafts (CVG) and valve-sparing root replacement (VSRR) operations, with an emphasis on postoperative conduction block and the need for permanent pacemaker implantation (PPM). METHODS:From 1997 to 2023, 1712 consecutive patients underwent ARR by VSRR (501 [29%]) or CVG (1211 [71%]) at a high-volume aortic center. RESULTS:Patients undergoing CVG were older (59 ± 14 vs 49 ± 14 years, P < .001), with more cardiovascular comorbidities. Compared with CVG, there were more women undergoing VSRR (17% vs. 13%, P = .042) and more patients with connective tissue disease (22% vs 7.3%, P < .001). Multivariable analysis found that the risk for PPM was higher after CVG compared with VSRR (6.5% vs 1.2%; odds ratio [OR], 2.83; 95% CI, 1.23-7.69; P = .024). Other variables associated with PPM include older age (OR, 1.03; 95% CI, 1.01-1.05; P = .006) preoperative renal impairment (OR, 2.69; 95% CI, 1.24-5.6; P = .010), previous operation (OR, 2.76; 95% CI, 1.29-5.62; P = .007), and bicuspid aortic valve (OR, 3.63; 95% CI, 2.13-6.33; P < .001). Among the CVG population, patients who are at increased risk are especially those with some degree of aortic stenosis (OR, 2.06; 95% CI, 1.18-3.61; P = .011). Patients who required PPM had no additive risk for long-term mortality (hazard ratio, 1.01; 95% CI, 0.47-2.17; P = .986); however, they were more likely to have reduced ejection fraction (29.3% vs 16%, P = .014). CONCLUSIONS:The incidence of PPM after ARR is low, but rates were higher after CVG compared with VSRR.

OBJECTIVE:Reoperative aortic root replacement (ARR) is a technically challenging procedure. This study assesses the influence of reoperation on outcomes following ARR, particularly after prior acute type A aortic dissection repair. METHODS:Of the 1823 patients in this study, 1592 (87.3%) underwent primary ARR, and 231 (12.7%) underwent reoperative ARR. Within the reoperative ARR group, 69 patients (29.9%) had previous acute type A aortic dissection repair, and 162 patients (70.1%) underwent reoperative ARR for other indications. RESULTS:Reoperative ARR patients exhibited higher rates of ischemic heart disease (13.9% vs 3%; P < .001), diabetes (10% vs 5.3%; P = .009), chronic pulmonary disease (9.1% vs 5%; P = .018), renal impairment (17.7% vs 5.3%; P < .001), and had lower ejection fraction (45.5% ± 8.1% vs 47.6% ± 7.9%; P < .001) compared with primary ARR. The overall operative mortality was 0.4%, with no significant difference between groups (0.9% vs 0.3%; P = .485). At multivariable analysis, previous operation was the most powerful predictor for major adverse events (odds ratio, 3.20; 95% CI, 2.12-4.79; P < .001). Reoperative ARR had a lower 10-year survival compared with primary ARR (67.4% vs 85.9%; log-rank P < .001). Multivariable analysis further confirmed that reoperation was significantly associated with 10-year mortality (hazard ratio, 1.76; 95% CI, 1.01-3.06; P = .044). Among the reoperative ARR group, operative mortality after previous acute type A aortic dissection repair was similar to that for other etiologies (0% vs 1.2%; P = .880). CONCLUSIONS:Patients undergoing reoperative ARR have more comorbidities and extensive aortic disease compared with those undergoing primary surgery. They face a 3.5-fold increased risk of major adverse events but no difference in operative mortality compared with primary ARR.