Complex Reoperative Thoracic Aortic Surgery

Abstract Reoperative aortic surgery encompasses a wide range of clinical indications and underlying pathologies. It has become more common in clinical practice as many patients return for treatment of residual arch and descending pathology after successful repair of acute type A dissection. Current available evidence is largely based on retrospective cohorts with highly variable clinical conditions. Major operative challenges include sternal reentry, organ protection, and hemostasis; with careful preoperative evaluation, meticulous intraoperative tissue handling, and organ protection strategies, favorable outcome can be achieved.