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Ann Thorac Surg 2002;74:S1777-S1780
© 2002 The Society of Thoracic Surgeons

Session 1: Ascending Aorta

Proximal aortic reoperations in patients with composite valve grafts

Scott A. LeMaire, MDa*, Daniel J. DiBardino, MDa, Cüneyt Köksoy, MDa, Joseph S. Coselli, MDa

a Cardiothoracic Surgery, Baylor College of Medicine, and the Methodist DeBakey Heart Center, Houston, Texas, USA

* Address reprint requests to Dr LeMaire, 6560 Fannin St, Suite 1100, Houston, TX77030, USA
e-mail: slemaire{at}bcm.tmc.edu

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

Abstract

BACKGROUND: The purpose of this study was to examine our experience with proximal aortic reoperations in patients with composite valve grafts (CVGs) and assess postoperative survival and morbidity.

METHODS: Since 1991, 33 patients with CVGs underwent reoperation for one or more of the following indications: aneurysms distal to the CVG (n = 20, 61%), false aneurysms (n = 13, 39%) and graft infection (n = 7, 21%). Operations included false aneurysm repair (n = 13, 39%), graft replacement of distal ascending aortic or transverse aortic arch aneurysm (n = 20, 61%) and aortic root re-replacement with a new CVG (n = 6, 18%) or homograft (n = 4, 12%).

RESULTS: Operative mortality was 15% (n = 5), including 2 of the 7 patients who had infected CVGs (29%). All 4 patients who had infected CVGs replaced with aortic root homografts survived. Complications included vocal cord paralysis (n = 4, 12%), bleeding requiring reoperation (n = 3, 9%) and stroke (n = 2, 6%). Actuarial 3-year survival was 74.4% ± 7.9%.

CONCLUSIONS: Reoperations in patients with CVGs remain challenging procedures with high associated morbidity and mortality, especially in the setting of graft infection. The results of homograft aortic root re-replacement for infected CVGs are encouraging.




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