Aortic Root Replacement after Aortic Valve or Ascending Aorta Surgery

Reoperative Aortic Root Replacement (RARR) is a complex and high-risk operation. We studied outcome of patients who underwent RARR after previous surgery on aortic valve, aortic root or ascending aorta. Between 1981 and 2006, 141 consecutive patients underwent 156 RARRs at the institution. Patient and peri-operative characteristics, short and long-term outcome were analyzed. Mean age was 37 years (0.3-76 years). RARR was performed on 56 prosthetic valves, 23 allografts, 28 pulmonary autografts and 49 native valves. RARR indications were: structural failure 47% (n = 72), neo-aortic root dilatation 18% (n = 28), aneurysm/dissection 13% (n = 21), endocarditis 15% (n = 24), non-structural failure 6% (n = 10) and valve thrombosis 1% (n = 1). About 36% (n = 56) received an allograft, 34% (n = 54) an aortic valve conduit (Bentall) and 30% (n = 46) a pulmonary autograft. Hospital mortality was 9% (n = 14): 14% (n = 8) prosthetic valve patients, 13% (n = 3) allograft patients, 6% (n = 3) native valve patients and 0% autograft patients died. Potential hospital mortality predictors were longer perfusion and cross clamp time, older patient age, female gender, unplanned CABG, concomitant mitral valve replacement and emergency surgery. During follow-up (mean 6.5 years, range 0-18 years), 13 patients died (LOR 1.3%/patient year); 8 prosthetic valves patients, 1 allograft patient, 3 native valve patients and 1 autograft patient. Overall 10 years survival was 78±4%; for prosthetic valve patients 65±8%, for allograft patients 82±8%, for native valve patients 87±5% and for autograft patients 96±4%. RARR can be safely performed. Especially, pulmonary autograft reoperation has low hospital mortality and morbidity rates with excellent survival. In this respect, these results may contribute to decision making in valve substitute selection in primary aortic valve replacement, especially in adolescents and young adults.