Clinical outcomes of aortic root replacement after previous aortic root replacement.

OBJECTIVE: The study objective was to examine the short- and long-term outcomes of reoperative aortic root replacement after a previous aortic root replacement.

METHODS: From September 1985 to February 2011, 84 consecutive patients underwent reoperative aortic root replacement. The patients' mean age was 46 ± 15 years (range, 19-80 years), and 86% were men. The main indication for reoperation was failed biological or bioprosthetic aortic valve and prosthetic valve endocarditis. Cox proportional hazard regression modeling was performed to identify risk factors that adversely affected overall survival.

RESULTS: The operative mortality was 6% (5 patients). Perioperative morbidity included myocardial infarction in 2 patients, low cardiac output syndrome in 7 patients, sepsis in 3 patients, pulmonary complications in 7 patients, renal failure in 3 patients, reoperation for bleeding or tamponade in 5 patients, superficial sternal wound infections in 3 patients, permanent transvenous pacemaker in 8 patients, and stroke in 1 patient. Kaplan-Meier estimates for survival at 5, 10, and 12 years were 82.5% ± 4.7%, 72.5% ± 6.4%, and 65.0% ± 7.6%, respectively; the freedom from reoperation was 100%, 92.3% ± 5.2%, 92.3% ± 5.2%, respectively; and valve-related mortality was 93.1% ± 3.4%, 90.8% ± 4.0%, and 86.2% ± 5.8%, respectively. During the follow-up, valve-related deaths occurred in 7 patients. Age by increments of 5 years (hazard ratio, 1.205; 95% confidence interval, 1.036-1.401) and prosthetic valve endocarditis (hazard ratio, 2.662; 95% confidence interval, 1.054-6.724) were independent risk factors for mortality.

CONCLUSIONS: Aortic root replacement after a previous aortic root replacement is associated with a relatively low operative mortality and perioperative morbidity, but long-term survival is suboptimal. Increasing age and prosthetic valve endocarditis adversely affect survival.