Reoperations versus primary operation on the aortic root: a propensity score analysis

Reported early outcomes for patients undergoing reoperations on the aortic root are worse than those for patients undergoing first-time surgery. The aim of this study was to review our experience with aortic root surgery by stratifying outcomes according to the type of intervention: reoperation versus primary operation on the aortic root. Of the 1267 patients undergoing aortic root surgery, 180 underwent aortic reoperation with root replacement (ARR) and 1087 underwent primary root replacement (PRR). Treatment bias was addressed by the use of propensity score (PS) matching and multivariate regression analysis. After PS matching, two groups of 116 patients each were created (ARR versus PRR). The primary end-points were in-hospital mortality and occurrence of postoperative complications. In the unmatched cohort, hospital mortality and postoperative complications rates were higher in the ARR group than in the PRR group (11.1 vs 4.1%, P < 0.001; 22.2 vs 15.1%, P = 0.02). Early results were greatly affected by the type of aortic disease. The in-hospital mortality rate was 3.1% for degenerative aneurysm, 13.3% for chronic dissection, 14% for acute dissection, 16.7% for active endocarditis and 25% for false aneurysm (P < 0.001). In the propensity-matched cohort, no significant differences were observed between the groups in terms of hospital mortality rate (ARR: 6%; PRR: 1.7%; P= 0.2) and postoperative complications (ARR: 16.4%; PRR: 14.7%; P = 0.9). Logistic regression analysis revealed cardiopulmonary bypass (CPB) time [odds ratio (OR): 1.03 per min; P < 0.001] and urgent/emergent status (OR: 6.4; P = 0.04) as independent risk factors for hospital deaths. Age (OR: 1.07 per year; P = 0.03) was the sole independent predictor of postoperative complications. During root surgery, reintervention did not affect early outcomes and was associated with satisfactory mortality and morbidity rates. In this setting, hospital results were heavily influenced by aortic pathology and the patient's profile.