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Original Articles: Adult Cardiac

Results of Reoperation on the Aortic Root and the Ascending Aorta

^a Division of Cardiac Surgery, Catholic University, Rome, Italy
^b Division of Cardiac Anesthesia, Catholic University, Rome, Italy
^c Division of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium

Accepted for publication April 29, 2011.

^_* Address correspondence to Dr Luciani, Division of Cardiac Surgery, Catholic University, Largo A. Gemelli, 8, 00168 Rome, Italy (Email: nicola.luciani{at}tiscali.it).

Background: Reoperations on the aortic root and the ascending aorta after previous aortic valve and proximal aortic surgery are increasingly frequent and highly demanding. The scarce comparability of the published series and the heterogeneity of clinical pictures contribute to the challenges of this subgroup.

Methods: Forty-one patients (2004 to 2010) who were reoperated on the aortic root and the ascending aorta for aneurysmal, pseudoaneurysmal, or infectious disease were retrospectively analyzed from a prospectively filled-in database.

Results: Mean logistic European system for cardiac operative risk evaluation was 29.8%. At index reoperation, procedures were classic Bentall (51%), prosthesis-sparing operation (17%), supracoronary ascending aortic replacement plus aortic valve replacement-repair (22%), and root replacement using valved homografts (9.7%). Distally, the operation involved the arch in 51% of cases (17 hemiarch replacement, 4 total transverse arch, 3 elephant trunk). Operative mortality was 12% and rate of major operative morbidity was 17%. At a mean 26-months follow-up, the patients surviving the operation had a good survival and functional class. The rate of adverse events during the follow-up was acceptable.

Conclusions: Reoperations on the aortic root-ascending aorta in the elective patients have respectable operative mortality-morbidity despite the high-risk profile, and are justified by the excellent follow-up survival. The mortality can be diminished by integrated surgical strategies and optimal myocardial protection. Our findings encourage complete resection of borderline dilated ascending aortic-root tissue at primary and redo operation.

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