Background. Reoperations on the aortic root and the ascending aorta ar
e being performed with increasing frequency and remain a challenging p
roblem. Methods. Eighty-one patients (age range, 14 to 78 years) under
went reoperations on the aortic root or the ascending aorta during a 1
4.5-year interval ending October 1996. The previous operations were ao
rtic valve procedure (28%), coronary artery bypass grafting (25%), aor
tic root replacement (24%), ascending aortic replacement (19%), and mi
scellaneous (5%). Twenty-two patients (27%) had had two or more previo
us operations. The principal indications for reoperation were true or
false aneurysm (35%), acute or chronic dissection (28%), and malfuncti
on of an aortic valve substitute (27%). The reoperations performed wer
e aortic root replacement (composite graft, allograft, or autograft) i
n 48 patients and graft replacement of the ascending aorta in 33 patie
nts. Concomitant procedures included aortic arch replacement in 43 pat
ients (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 > 0.05). Using stepwise multivariate logistic regression analysis of
23 variables, preoperative functional class III/IV (p = 0.047) and du
ration of cardiopulmonary bypass (p = 0.007) were significant independ
ent 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%, a
nd 69%, respectively. Freedom from reoperation on the heart or ascendi
ng aorta was 98%, 92%, and 69%, respectively. Reoperation for false an
eurysm (p = 0.050) and the presence of coexisting coronary artery dise
ase requiring bypass grafting (p = 0.010) were the only significant pr
edictors of late mortality. Conclusions. Reoperations on the aortic ro
ot and the ascending aorta can be accomplished with acceptable early m
ortality and satisfactory long-term results. More frequent resection o
f the aneurysmal or dissected segments of the ascending aorta and aort
ic root at the initial operation may reduce the need for subsequent re
operation. (C) 1997 by The Society of Thoracic Surgeons.