Background/Objectives: The influence of surgeon expertise on patients’ outcomes after repair of acute type A aortic dissection (ATAAD) is not well established. The aim of this paper is to report the results of ATAAD repair performed by expert (ES) and not expert aortic surgeons (NES) in our center. Methods: We have retrospectively divided 199 patients into two groups according to the first surgeon experience (ES = 138 patients and NES = 61 patients), all being members of the aortic team. We evaluated and compared early and long-term outcomes. Results: Although the two groups were comparable in terms of clinical presentation and intraoperative setting, ES performed more aortic arch repairs (40% vs. 26%, p = 0.06) and frozen elephant trunk procedures (15% vs. 3%, p = 0.02), albeit with similar intraoperative times (median cardiopulmonary bypass time of 203 min in ES vs. 201 min in NES, respectively, p = 0.88). The 30-day mortality was the same in the two groups (8%, p = 1), and the postoperative course was similar except for a shorter in-hospital stay in the NES group (10 vs. 17 days, p = 0.04). Conclusions: In our experience, repair of ATAAD could be achieved with similar results between ES and NES. However, NES performed less technically demanding repairs. With standardization of pre-, intra-, and post-operative management, NES can be expected to increase their technical skills and be progressively involved in more complex ATAAD repairs without adversely affecting surgical results.

Background: Heart re-transplantation represents an effective option in selected patients with graft failure. Although the results of heart re-transplantation have improved in recent years, little is known about the outcomes in patients requiring late (>1 year) re-transplantation or about the effects of prolonged exposure to immunosuppression on multiorgan function. Methods: Among all the heart re-transplantations performed, from November 1988 to April 2025, a total of 30 patients underwent late re-transplantation. Since literature data on late re-HTx are generally limited to those performed within 20 years, patients were divided according to the interval from primary to re-transplantation: <20 (Group A) or ≥20 years (Group B). Results: Group A included 17 patients re-transplanted after a median time of 15 years, and Group B 13 patients after a median time of 23 years. Group B patients were more commonly affected by severe chronic kidney disease and received more combined heart and kidney transplantation. Overall survival at 1, 5 and 10 years was 80%, 68% and 60%, and did not differ between Groups A and B (p = 0.5). However, Group B recipients were more commonly affected by malignancies (p < 0.01). Compared to primary heart transplantation in the same population, re-transplantation was associated with higher, albeit not statistically significantly, rates of infections, grade ≥ 2 rejections and malignancies. Conclusions: Late heart re-transplantation is associated with satisfactory outcomes and could be effectively considered in patients with late graft dysfunction. However, the prolonged exposure to immunosuppression requires particular attention in early pharmacological management as well as a close follow-up, especially in patients requiring heart re-transplantation after >20 years.