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  • Title: Reoperative aortic root replacement in patients with previous aortic surgery.
    Author: Szeto WY, Bavaria JE, Bowen FW, Geirsson A, Cornelius K, Hargrove WC, Pochettino A.
    Journal: Ann Thorac Surg; 2007 Nov; 84(5):1592-8; discussion 1598-9. PubMed ID: 17954067.
    Abstract:
    BACKGROUND: Reoperative aortic root reconstruction is increasingly performed and remains a clinical challenge. The aim of this study is to evaluate the outcome of patients undergoing reoperative aortic root replacement after previous aortic surgery. METHODS: From 1995 to 2006, 156 consecutive patients underwent reoperative aortic root replacement after previous aortic valve replacement (group 1, n = 106, 67.8%), proximal aortic reconstruction (group 2, n = 25, 16.1%), and aortic root replacement (group 3, n = 25, 16.1%). Their records were retrospectively reviewed. RESULTS: The mean age was 58.1 +/- 14.4 years, and 73.7% (n = 115) were men. Reoperation was performed 98.4 months after previous operation, with 14.7% (n = 23) having undergone three or more sternotomies. Indications for reoperations were endocarditis in 55 (35.3%), prosthetic valve dysfunction in 28 (17.9%), paravalvular leak in 12 (7.7%), aortic aneurysm or pseudoaneurysm in 29 (18.5%), aortic dissection in 12 (7.7%), and aortic stenosis or insufficiency in 20 (12.9%). Aortic root replacement was performed in all 156 patients, with concomitant hemiarch reconstruction in 62 (39.7%), Cabrol coronary reconstruction in 5 (3.2%), coronary artery bypass grafting (CABG) in 26 (16.6%), and mitral valve repair or replacement (MVR) in 25 (16.0%). Thirty-day mortality was 11.5% (n = 18). Actuarial survival was 86.4% +/- 2.7% at 1 year, 72.6% +/- 4.3% at 5 years, and 58.4% +/- 7.8% at 10 years. Subgroup analysis demonstrated no difference in 30-day mortality (group 1, 14.1%; group 2, 8.0%; group 3, 4.0%; p = 0.31) and late survival between the three groups (p = 0.14). Multivariate analysis demonstrated age older than 75 years (p = 0.03) and New York Heart Association (NYHA) functional class IV (p = 0.05) as risk factors for 30-day mortality. CONCLUSIONS: Reoperative aortic root reconstruction can be performed with a low perioperative mortality rate and satisfactory long-term survival. Age older than 75 years and NYHA class IV are risk factors for early mortality. Previous aortic root replacement is not a risk factor for reoperative aortic root reconstruction.
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