Midterm Outcomes of Graft Insertion Technique for Redo Aortic Root Surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Innovation

Background:

• Reconstruction of the left ventricular outflow tract (LVOT) and aortic root presents challenges, particularly in high-risk patients.
• Existing techniques may have limitations in complex cases requiring redo surgery.

Purpose of the Study:

• To evaluate the midterm outcomes of the graft insertion technique (GIT) for LVOT and aortic root reconstruction.
• To assess the incidence of adverse aortic events (AAEs) following GIT.

Main Methods:

• A consecutive series of 14 high-risk patients underwent GIT for LVOT and aortic root reconstruction between August 2014 and March 2024.
• Indications included prosthetic valve endocarditis (9 patients) and noninfectious pseudoaneurysm (5 patients).
• Mean EuroSCORE II was 28.8 ± 17.6, with seven patients undergoing aortic root surgery.

Main Results:

• Mean operation time was 504 ± 87 minutes, with cardiopulmonary bypass and aortic cross-clamp times of 311 ± 41 and 240 ± 45 minutes, respectively.
• Operative mortality was 7.1% (1 patient), and 35.7% (5 patients) died within the first year.
• No surviving patients experienced recurrent endocarditis or cardiovascular events/infections after the second year. Crucially, no AAEs were observed on CT during follow-up.

Conclusions:

• The graft insertion technique (GIT) is a viable alternative for complex aortic root and LVOT reconstruction in high-risk surgical candidates.
• GIT demonstrated promising midterm safety, with no observed adverse aortic events in surviving patients.