Early and long-term outcomes for patients undergoing reoperative aortic root replacement

OBJECTIVES: There are limited data on aortic root replacement (ARR) in patients with previous cardiac surgery. We analysed short-term and long-term results for patients with ARR after previous cardiac surgery. METHODS: From September 1995 to April 2015, 130 patients underwent reoperative ARR. Fifty patients had undergone ARR previously (Group I), and 80 had been treated by isolated aortic valve repair or replacement (Group II). The primary indications for surgery were active endocarditis in 65 patients (50%), aneurysmatic root dilatation in another 37 (28.5%) and valve failure in 27 (20.8%). RESULTS: Overall hospital mortality was 10% (n = 13). Survival at 10 and 15 years was 59.4% and 40.6%, respectively. Survival at 10 and 15 years was 71.5% and 62.5% in Group I and 56.2% and 35.4% in Group II, respectively (P = 0.14). Survival was significantly worse in patients operated for active endocarditis (23.7% vs 56.4% at 15 years; P < 0.001). Inferior 15-year survival was also observed for patients requiring concomitant surgery for cardiac comorbidities (10.5% vs 48.7%; P = 0.003) and in the elderly (≥60 years; 26.8% vs 59.5%; P < 0.001). Ten-year survival was best in patients after valve-preserving root replacement (100%). Multivariable analysis revealed age, active endocarditis and concomitant surgery for cardiac comorbidities as risk factors for death. CONCLUSIONS: ARR after previous cardiac surgery can be performed with reasonable short-term and long-term survival. It is inferior in patients with active endocarditis or cardiac comorbidities and in the elderly. In these scenarios, less invasive procedures may be considered where applicable.