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Original Articles: Cardiovascular

Reoperative Aortic Root Replacement in Patients With Previous Aortic Surgery

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Accepted for publication May 21, 2007.

^_* Address correspondence to Dr Szeto, Division of Cardiovascular Surgery, Department of Surgery, Hospital of University of Pennsylvania, University of Pennsylvania Medical Center, 3400 Spruce St, 6th Silverstein, Philadelphia, PA 19104 (Email: szetow{at}uphs.upenn.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

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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