Reoperative aortic root replacement: Outcome in a contemporary series

Abstract Objectives Reoperative aortic root replacement is a challenging procedure associated with significant mortality and morbidity. The purpose of this study was to investigate the outcomes of reoperative aortic root replacement when performed in a number of complex clinical settings and to identify risk factorsfor operative mortality and long-term survival. Methods From 2006 to 2015, 280 consecutive patients at an academic center underwent reoperative aortic root replacement after a variety of previous aortic or cardiac operations. Logistic regression and extended Cox proportional hazards regression analyses were used to determine risk factorsfor operative mortality and long-term survival, respectively. Results The mean age of patients was 52.5 ± 14.1 years. Prior operations included proximal aortic replacement in 113 patients, valve surgery in 162 patients, and coronary artery bypass grafting in 46 patients. Concomitantprocedures included arch replacement in 135 patients, coronary artery bypass grafting in 68 patients, and mitral valve repair/replacement in 18 patients. Operative mortality was 14.3%. Five-year survival was 74.0%. Univariable analysis did not find previous root replacement, prior proximal aortic surgery, and concomitantarch replacement to be risk factorsfor operative mortality. In the multivariable analysis, chronic lung disease, prior myocardial infarction, and concomitant mitral valvesurgery were risk factorsfor operative mortality. Age, peripheral artery disease, emergency, and concomitant mitral valvesurgery were risk factorsfor mortality in the late phase. Conclusions Reoperative aortic root replacement represents complex procedures carrying significant morbidity and mortality. Chronic lung disease, prior myocardial infarction, and concomitant mitral valvesurgery were risk factorsfor operative mortality. Age, peripheral artery disease, emergency, and concomitant mitral valvesurgery were risk factorsfor long-term mortality.