Table 5.

Cause of death for patients with previous cardiac surgery who died in-hospital

Case	PCS	Age at ATAAD Repair	Year of ATAAD Repair	Years Between	ATAAD Procedure	Preoperative MPS	ATAAD Preoperative Complications	ATAAD Postoperative Complications	Date of Death	Cause of Death
1	MV repair, TV repair, Maze	63	2003	0.12	Root, ascending, and zone 2 arch replacement, CABG × 1	No	coagulopathy; cardiogenic shock	-	POD # 0	Operation required extended CPB time, unable to wean from bypass.
2	AVR	39	2007	22.5	Root, ascending, and hemiarch replacement	Yes	Mesenteric, celiac, and renal MPS	Required ECMO, he was oliguric, hyperkalemic, and required dialysis. Bowel ischemia with exploratory laparotomy and ileocecectomy	POD # 2	Necrotic bowel, Multi-system organ failure. Withdrawal of care.
3	ASD/VSD repair	37	2010	32	Root repair, ascending, and hemiarch replacement	No		Acute MI, acute liver injury, new-onset acute renal failure, pneumonia, ITP with post-transfusion purpura	POD # 52	Severe thrombocytopenia, mesenteric ischemia and necrosis, patient made DNR with continuation of care without escalation (no dialysis). Patient expired.
4	MV repair, AVR, ascending replacement*	78	2012	0.01	Root repair	No	Preop CPR	Neuro exam revealed pupil and corneal reflex activity, and gag reflex only. He developed seizure like activity and myoclonic jerking. Head CTs negative for intracranial process.	POD # 6	Remained neurologically unresponsive, made comfort care.
5	AVR, MVR, Cox-Maze	57	2014	9	Root, ascending, and hemiarch replacement	Yes	Marfan syndrome, acute MI, coronary MPS, cardiogenic shock	ECMO, paralysis probably due to dissection and thrombosis of intercostal arteries.	POD # 10	After decannulation from ECMO patient became oliguric, hyperkalemic, extremities appeared dusky with pulses intact, family withdrew care.
6	AVR	73	2016	22	Ascending and hemiarch replacement	Yes	Renal and lower extremity MPS	Sepsis, pneumonia, tracheostomy, acute kidney injury on top of existing chronic kidney disease requiring dialysis, ischemic bowel, colectomy and end colostomy for necrotic bowel performed. Mental status declined, subacute cerebral ischemia, and endocarditis	POD # 79	Given inability to treat pneumonia, new finding of endocarditis with concern for septic emboli to the brain, renal failure, and poor prognosis, patient was made comfort care.

^*The patient developed aortic root dissection 3 days after initial MVR, AVR, and ascending aortic replacement.

ASD=atrial septal defect; ATAAD=acute type A aortic dissection; AVR=aortic valve replacement; CABG=coronary artery bypass graft; CPB=cardiopulmonary bypass; CPR=cardiopulmonary resuscitation; DNR=do not resuscitate; ECMO=extracorporeal membrane oxygenation; IR=interventional radiology; ITP=idiopathic thrombocytopenic purpura; MI=myocardial infarction; MPS=malperfusion syndrome; MV=mitral valve; MVR=mitral valve replacement; PCS=previous cardiac surgery; POD=postoperative day; TV=tricuspid valve; VSD=ventricular septal defect