REOPERATIONS ON THE AORTIC ROOT AND ASCENDING AORTA

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.