Reoperations on the Aortic Root: Experience in 46 Patients

Background. The increasing use of biologic conduits and the advances in reparative aortic root procedures has increased the number of patients who may require reoperation on the aortic root. Although the primary operation yields excellent results with a low risk for morbidity and mortality, reoperation on the aortic root is still challenging. Methods. We reviewed retrospectively our experience in 46 patients (38 men; mean age, 57 +/- 11 years) who underwent aortic root reoperations in the last 7 years. Of these, 42 had received prior aortic root replacement. The indications for reoperation included prosthesis infection in 16, false aneurysm in 16, and degenerative or postdissection aneurysm and valve prosthesis failure. Aortic root re-replacement was performed in 39 patients (85%) and closure of false aneurysm in 7. Univariate and multivariate analysis on 22 perioperative variables were performed. Results. In-hospital mortality was 6.5% (3 patients). The postoperative course was complicated in 19 (41%). At multivariate analysis, perioperative myocardial infarction was a risk factor for hospital mortality (2 patients). Survival was 88% at 1 year and 74% at 5 years. No differences were found in survival according to redo indication. Freedom from reoperation on the aortic root was 100% at 1 year and 90% at 5 years. Conclusions. Reoperation on the aortic root can be performed with acceptable mortality and good midterm and long-term outcome; however, the postoperative complication rate is still high. (Ann Thorac Surg 2010; 89: 81-6) (C) 2010 by The Society of Thoracic Surgeons