Comparative outcomes of first-time versus redo aortic root replacement in patients with prior sternotomy: A...

Aortic root replacement (ARR) is a challenging procedure that requires aortic root implantation, coronary reimplantation, and concomitant aortic and valve surgery. Prior sternotomy (PS) increases case complexity for patients requiring ARR. We aimed to compare outcomes in PS patients undergoing primary ARR and patients undergoing true redo ARR.

This single-center retrospective study included adult patients (≥18 years) undergoing ARR after a PS between 2011 and 2023. Descriptive statistics were compared between the primary ARR and true redo ARR groups. Continuous and categorical variables were reported. Associations between groups were determined, with a P value < .05 considered significant.

A total of 394 patients with history of PS underwent ARR, including 324 with primary ARR and 70 with true redo ARR. There were no differences in baseline comorbidities between groups, with most undergoing true redo ARRs for endocarditis (34.3%). True redo ARR patients were more likely to undergo a "modified Cabrol" for coronary management (17.9% for primary ARR vs 51.4% for true redo ARR; P < .001). There were no between-group differences in cardiopulmonary bypass time (P = .123), permanent cerebrovascular accident (3.7% for primary ARR vs 4.3% for true redo ARR; P = .518), in-hospital mortality (6.8% vs 7.1%; P = .514), and estimated longitudinal survival at 5 years following ARR (82.2% vs 81.5%; P = .82).

ARR in PS patients can be performed safely with good short- and long-term outcomes. Despite the challenges associated with reoperative aortic root surgery, there was no increase in adverse outcomes for primary ARR compared with true redo ARR.