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Aortic root replacement in patients with previous heart surgery.

Tirone E David1, Christopher M Feindel, Joan Ivanov

  • 1Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca

Journal of Cardiac Surgery
|July 13, 2004
PubMed
Summary

Redo aortic root replacement has low operative mortality in elective cases. Long-term results are satisfactory, comparable to initial aortic root replacement, though risk increases with age and emergent surgery.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Redo aortic root replacement is a complex procedure.
  • Prosthetic aortic valve dysfunction is a primary indication for reoperation.
  • Patients often present with dilated, calcified, or ruptured aortic roots.

Purpose of the Study:

  • To review the operative risk and outcomes of redo aortic root replacement.
  • To assess the mortality and morbidity associated with repeat aortic root surgery.
  • To evaluate long-term survival and freedom from reoperation after redo aortic root replacement.

Main Methods:

  • A retrospective review of 165 patients undergoing redo aortic root replacement from July 1990 to December 2001.
  • Patients had a mean age of 49 years, with 78% being male.

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  • Follow-up extended up to 12.5 years (mean 3.8 years).

    • Main Results:

    • Operative mortality was 7% (12 patients), and late mortality was 12% (20 patients).
    • Eight-year survival was 68% ± 6%, with cardiovascular causes being the primary reason for death.
    • Independent predictors of death included age and preoperative New York Heart Association functional class IV.

    Conclusions:

    • Redo aortic root replacement can be performed with low operative mortality in elective settings.
    • Operative risk increases for patients requiring emergent surgery or those who are older.
    • Long-term outcomes are satisfactory and comparable to first-time aortic root replacement.