Early and long-term results of reoperative total aortic root replacement with reimplantation of the coronary arteries

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 142; no. 6; pp. 1473 - 1477
• Main Authors: El-Hamamsy, Ismail, MD, PhD, Ibrahim, Michael, BA (Cantab), Stevens, Louis-Mathieu, MD, Witzke, Herbert, MD, Clark, Lucy, PhD, Yacoub, Magdi H., FRS
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta - surgery; Aortic Valve - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Cardiothoracic Surgery; Child; Coronary Vessels - surgery; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Male; Medical sciences; Middle Aged; Pneumology; Reoperation; Replantation; Young Adult; 35.2; 35.3.1; Prognosis; Root; Coronary artery; Replacement; Long term; Treatment; Surgery; Total; Anesthesia; Aorta; Early; Circulatory system; Cardiology; Replantation
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2011.04.004

Background Total root replacement with biologic valves and reimplantation of the coronaries gives good early and midterm results. There is continuing concern, however, regarding the risks and long-term results for reoperation after total replacement of the aortic root with reimplantation of the coronaries. Methods Between June 1981 and July 2010, a total of 84 patients underwent reoperative aortic root replacement with reimplantation of the coronaries (60 male, mean age 38 ± 15 years). All patients had undergone first-time total aortic root replacement with homografts (82 patients) or autografts (2 patients). Indication for reoperation was structural valve deterioration in 72 patients (85%) and infective endocarditis in 12 patients (15%). Mean interval between first operation and reoperation was 11.1 ± 4.7 years (range, 1 month–24.7 years). Median length of follow-up was 9.7 ± 5.6 years (range, 1 month–24.4 years). Results Thirty-day mortality was 2.4% (n = 2 patients). Both patients died postoperatively of low-output syndromes with multiorgan failure. At reoperation, 74 patients received homografts (87%), 7 patients underwent a Ross procedure (9%), and 3 received stentless porcine roots (4%). One patient required pacemaker implantation (1%). Actuarial survivals were 89% ± 4% and 81% ± 5% at 5 and 10 years, respectively. Nine patients underwent a successful third root replacement during follow-up. Freedom from third-time aortic root operation was 97% ± 3% at 10 years. Conclusions Reoperative aortic root replacement can be performed safely with good short-term and midterm outcomes in a young patient cohort.