Are early outcomes of reoperative aortic root surgery impacted by previous root procedure and indication for reintervention?

Abstract

Objective

Reoperative aortic root surgery after a previous root procedure is technically demanding, which can impact outcomes. Herein, we examined the impact of previous root procedure and operative indication on early outcomes.

Methods

From January 2010 to December 2022, 632 patients underwent reoperative aortic root surgery after previous root procedure (true redo root) at our institution. Baseline characteristics, operative details, and in-hospital complications were compared between groups on the basis of type of previous root prosthesis and infective endocarditis indication.

Results

In the whole cohort, the operative mortality was 2.2% and estimated survival was 93%, 80%, and 67% at 1, 5, and 10 years, respectively. Operative mortality was similar between previous homograft, Bentall, Freestyle, valve-sparing root reimplantation, and Ross (2%, 4%, 0%, 4%, and 0%, respectively, P = .4). Reoperations after Bentall and valve-sparing root reimplantation (prosthetic grafts) had greater rates of postoperative complications, such as reoperation for bleeding (15% and 8%, P = .01), delayed chest closure (18% and 8%, P = .02), and pacemaker insertion (13% and 12%, P = .03). Although there was no significant difference in operative mortality among patients with endocarditis versus those with other indications (3% vs 1%, P = .08), the postoperative course showed greater rates of reoperation for bleeding (19% vs 5%, P < .01) and prolonged ventilation (38% vs 18%, P < .01).

Conclusions

At experienced centers, aortic root reoperation (true redo root) can be performed with low operative mortality. Explant of prosthetic graft material and endocarditis are associated with more complicated postoperative course, without significantly increased operative mortality.