Outcomes of aortic root replacement after previous aortic root replacement: the "true" redo root.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Valve Surgery

Background:

• Aortic reoperations, particularly redo aortic root replacement, present significant technical challenges.
• Understanding outcomes stratified by the cause of prosthesis failure is crucial for surgical planning.

Purpose of the Study:

• To evaluate outcomes of "true" redo aortic root replacement (previous full root replacement).
• To stratify outcomes based on the reason for prosthesis failure: structural valve deterioration versus endocarditis.

Main Methods:

• A comparative study involving 793 patients undergoing first-time sternotomy (de novo group) and 120 patients with prior full aortic root replacement (redo group).
• The redo group was further divided into degenerative failure (n=76) and endocarditis (n=44).
• Outcomes including mortality, morbidity, and long-term survival were analyzed.

Main Results:

• Overall perioperative mortality was similar between de novo (4%) and redo (5%) groups (p=0.43).
• The infection group experienced significantly higher rates of renal failure, sternal infection, prolonged ventilation, and sepsis compared to the degenerative and de novo groups.
• Five-year survival was comparable for de novo (86.3%) and degenerative redo groups (86.3%), but significantly lower for the infection redo group (65.3%).

Conclusions:

• Redo aortic root replacement can be performed with low perioperative morbidity and mortality.
• Infection is a significant risk factor, increasing complications and reducing survival after redo aortic root replacement.
• Reoperation for degenerative valve failure demonstrates similar short-term risks and midterm survival compared to primary aortic root replacement.