BACKGROUND: Aortic reoperations are technically challenging. This study evaluated outcomes after "true" redo root replacement (previous full root replacement) stratified by cause of prosthesis failure. METHODS: Data were compared for 793 patients who underwent a first-time sternotomy (de novo group) and 120 patients who had previously undergone full aortic root replacement (redo group), of which 76 underwent reoperation due to structural valve deterioration (degenerative group), and 44 due to endocarditis (infection group). RESULTS: Overall mortality was 4% (n = 28) in the de novo group and 5% (n = 6) in the redo group (p = 0.43) (degenerative group, 3%, infection group, 9%; p = 0.19). The infection group had an increased incidence of renal failure, sternal infection, prolonged ventilation, reoperation for bleeding, multisystem failure, and sepsis, and an increased hospital length of stay. The degenerative group and the de novo group had a similar risk of perioperative death and major complications. The 5-year survival was 86.3% ± 1.3% for the de novo group and 77.3% ± 4.6% for the redo group (p ≤ 0.01; degenerative, 86.3% ± 5%; infection, 65.3% ± 7.7%; p < 0.01; p = 0.98 for de novo vs degenerative). Multivariate analysis demonstrated that reoperation for degenerative failure did not increase the risk of perioperative or late death. CONCLUSIONS: Redo aortic root replacement can be performed with low perioperative morbidity and death. The presence of infection increases the risk of complications and worsens survival. However, redo root replacement for degenerative failure can be performed with similar short-term complication risk and midterm survival as de novo root replacement.
BACKGROUND: Aortic reoperations are technically challenging. This study evaluated outcomes after "true" redo root replacement (previous full root replacement) stratified by cause of prosthesis failure. METHODS: Data were compared for 793 patients who underwent a first-time sternotomy (de novo group) and 120 patients who had previously undergone full aortic root replacement (redo group), of which 76 underwent reoperation due to structural valve deterioration (degenerative group), and 44 due to endocarditis (infection group). RESULTS: Overall mortality was 4% (n = 28) in the de novo group and 5% (n = 6) in the redo group (p = 0.43) (degenerative group, 3%, infection group, 9%; p = 0.19). The infection group had an increased incidence of renal failure, sternal infection, prolonged ventilation, reoperation for bleeding, multisystem failure, and sepsis, and an increased hospital length of stay. The degenerative group and the de novo group had a similar risk of perioperative death and major complications. The 5-year survival was 86.3% ± 1.3% for the de novo group and 77.3% ± 4.6% for the redo group (p ≤ 0.01; degenerative, 86.3% ± 5%; infection, 65.3% ± 7.7%; p < 0.01; p = 0.98 for de novo vs degenerative). Multivariate analysis demonstrated that reoperation for degenerative failure did not increase the risk of perioperative or late death. CONCLUSIONS: Redo aortic root replacement can be performed with low perioperative morbidity and death. The presence of infection increases the risk of complications and worsens survival. However, redo root replacement for degenerative failure can be performed with similar short-term complication risk and midterm survival as de novo root replacement.
Authors: Adriaan W Schneider; Mark G Hazekamp; Michel I M Versteegh; Arend de Weger; Eduard R Holman; Robert J M Klautz; Eline F Bruggemans; Jerry Braun Journal: Eur J Cardiothorac Surg Date: 2019-12-01 Impact factor: 4.191
Authors: Alexander Horke; Igor Tudorache; Günther Laufer; Martin Andreas; Jose L Pomar; Daniel Pereda; Eduard Quintana; Marta Sitges; Bart Meyns; Filip Rega; Mark Hazekamp; Michael Hübler; Martin Schmiady; John Pepper; U Rosendahl; Artur Lichtenberg; Payam Akhyari; Ramadan Jashari; Dietmar Boethig; Dmitry Bobylev; Murat Avsar; Serghei Cebotari; Axel Haverich; Samir Sarikouch Journal: Eur J Cardiothorac Surg Date: 2020-11-01 Impact factor: 4.191
Authors: Alexander Horke; Dmitry Bobylev; Murat Avsar; Bart Meyns; Filip Rega; Mark Hazekamp; Michael Huebler; Martin Schmiady; Ioannis Tzanavaros; Robert Cesnjevar; Anatol Ciubotaru; Günther Laufer; Daniel Zimpfer; Ramadan Jashari; Dietmar Boethig; Serghei Cebotari; Philipp Beerbaum; Igor Tudorache; Axel Haverich; Samir Sarikouch Journal: Eur J Cardiothorac Surg Date: 2020-10-01 Impact factor: 4.191