Outcomes of Aortic Root Replacement After Previous Aortic Root Surgery

ABSTRACT Objective To determine the impact of reoperative aortic root replacement (ARR) on short-term outcomes and survival. Methods This was a retrospective study of aortic root operations from 2010-2018. All patients with a complete ARR were included, while patients undergoing valve-sparing root replacements were excluded. Patients were dichotomized by first-time sternotomy versus redo sternotomy, which was defined as having had a prior sternotomy for whatever reason. Within the redo sternotomy group, reoperative ARRs were identified, being defined as a complete ARR in patients with a prior ARR. 1:1 nearest neighbor propensity matching was employed to compare outcomes across groups. Kaplan-Meier survival estimates were generated and compared using log-rank statistics. Results A total of 893 patients undergoing complete ARR were identified, of which 595 (67%) underwent first-time sternotomy, while 298 (33%) underwent redo sternotomy. After matching, postoperative outcomes were similar for the first-time and redo sternotomy groups, including operative mortality. Redo sternotomy was not associated with reduced survival after ARR, compared to first-time sternotomy (p=0.084), with 5-year survival being 73.7% for first-time sternotomy and 72.9% for the redo sternotomy. Of the redo sternotomy group (n=298), 69 (23%) were reoperative ARR, while 229 (77%) were first-time ARR. After matching, postoperative outcomes were similar for the first-time and reoperative ARR groups, including operative mortality. Reoperative ARR was not associated with reduced survival, compared to first-time ARR (p=0.870), with 5-year survival being 67.9% for first-time ARR and 72.1% for reoperative ARR. Conclusions Reoperative ARR can be safely performed and provides similar survival to first-time ARR.