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Original Articles: Adult Cardiac

Ascending Aorta and Aortic Root Reoperations: Are Outcomes Worse Than First Time Surgery?

^a Unit of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
^b Unit of Cardiology, Hospital Clínico San Carlos, Madrid, Spain

Accepted for publication March 29, 2010.

^_* Address correspondence to Dr Silva, Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, Madrid 28040, Spain (Email: jsilva8252{at}yahoo.es).

Background: The aim of this study was to analyze surgery and survival data in the midterm after aortic root and (or) ascending aorta reoperations and compare these results with those obtained after first time surgery.

Methods: Over a 6-year period, 365 patients underwent an aortic root and (or) ascending aorta surgery procedure at our center. Mean patient age was 63.1 ± 25.5 years; 27.1% were women. Fifty-eight patients had had prior ascending aorta and (or) aortic valve surgery (group I) and the remaining 307 patients were assigned to an initial surgery group (II). The reoperative procedures were Bentall in 45 (77.6%), ascending aorta and valve replacement in 8 (13.8%), and ascending aorta replacement in 5 (8.6%).

Results: The reoperation group showed a worse preoperative risk profile indicated by a higher logistic European system for cardiac operative risk evaluation: group I (26.9) versus group II (9.9) (p < 0.0001). Hospital mortality was 7 of 58 (12.1%) in group I and 21 of 207 (6.8%) in group II (p = 0.18; relative risk 1.9 [0.8 to 4.6]). After adjusting for the different variables, reoperation could not be identified as an independent predictor of postoperative morbidity. Survival rates (including in-hospital mortality) were lower in group I at one year (77.9 ± 1.11% vs 91.9 ± 0.3%) and at 3 years (75.3 ± 0.11% vs 88.9 ± 0.03% [log-rank p = 0.005]). In the multivariate analysis, reoperation (p = 0.01; hazard ratio 2.6 [1.2 to 5.3]) was a determining factor for survival once corrected for variables predicting mortality during follow-up.

Conclusions: Reoperations on the ascending aorta and aortic root showed acceptable morbidity and mortality. Their midterm survival was lower than for patients not requiring a repeat operation.

This article has been cited by other articles:

				N. Luciani, R. De Geest, A. Anselmi, F. Glieca, S. De Paulis, and G. Possati Results of Reoperation on the Aortic Root and the Ascending Aorta Ann. Thorac. Surg., September 1, 2011; 92(3): 898 - 903. [Abstract] [Full Text] [PDF]