Reoperations on the aortic root and ascending aorta

Abstract

Background. Reoperations on the aortic root and the ascending aorta are being performed with increasing frequency and remain a challenging problem. Methods. Eighty-one patients (age range, 14 to 78 years) underwent reoperations on the aortic root or the ascending aorta during a 14.5-year interval ending October 1996. The previous operations were aortic valve procedure (28%), coronary artery bypass grafting (25%), aortic root replacement (24%), ascending aortic replacement (19%), and miscellaneous (5%). Twenty-two patients (27%) had had two or more previous operations. The principal indications for reoperation were true or false aneurysm (35%), acute or chronic dissection (28%), and malfunction of an aortic valve substitute (27%). The reoperations performed were aortic root replacement (composite graft, allograft, or autograft) in 48 patients and graft replacement of the ascending aorta in 33 patients. Concomitant procedures included aortic arch replacement in 43 patients (55%) and coronary artery bypass grafting in 33 patients (41%). Results. The 30-day mortality rate was 8.6% (7 patients). It was 8.3% for aortic root replacement and 9.1% for ascending aorta replacement (p > 0.08). Using step-wise multivariate logistic regression analysis of 23 variables, preoperative functional class III/IV (p = 0.047) and duration of cardiopulmonary bypass (p = 0.007) were significant independent predictors of early death. The mean duration of follow-up was 3.6 years. The 1-year, 5-year, and 10-year survival rates were 89%, 81%, and 69%, respectively. Freedom from reoperation on the heart or ascending aorta was 98%, 92%, and 69%, respectively. Reoperation for false aneurysm (p = 0.080) and the presence of coexisting coronary artery disease requiting bypass grafting (p = 0.010) were the only significant predictors of late mortality. Conclusions. Reoperations on the aortic root and the ascending aorta can be accomplished with acceptable early mortality and satisfactory long-term results. More frequent resection of the aneurysmal or dissected segments of the ascending aorta and aortic root at the initial operation may reduce the need for subsequent reoperation.