Aortic root replacement after repaired congenital conotruncal defects: A surgical challenge

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Aortic Surgery

Background:

• Aortic root replacement (ARR) presents unique challenges in patients with a history of repaired conotruncal defects.
• These complex congenital heart conditions often necessitate multiple prior interventions.

Purpose of the Study:

• To evaluate the outcomes of aortic root replacement (ARR) in patients who have undergone prior repair of conotruncal defects.
• To assess the feasibility of valve-sparing techniques and overall survival in this specific patient cohort.

Main Methods:

• Retrospective review of 2710 aortic root replacement (ARR) cases between 2004 and 2021.
• Identification of 18 patients (0.7%) with prior conotruncal defect repair, including various subtypes.
• Analysis of surgical history, baseline characteristics, hospital course, and survival using Kaplan-Meier estimates.

Main Results:

• The study identified 18 patients with a median age of 15-68 years undergoing ARR for aortic aneurysm or insufficiency.
• Patients had a history of multiple sternotomies (50% had ≥1), and valve-sparing ARR was rarely performed (16.7%).
• In-hospital mortality was 16.7% (3 deaths), and the 5-year survival probability was 76.2%.

Conclusions:

• Aortic root pathology requiring ARR is an infrequent complication following repaired conotruncal defects.
• Valve-sparing aortic root replacement is seldom feasible in this patient population.
• Given the significant mortality and complexity, careful consideration is warranted for ARR in patients with repaired conotruncal defects.