REOPERATIVE AORTIC-VALVE OPERATION AFTER HOMOGRAFT ROOT REPLACEMENT -SURGICAL OPTIONS AND RESULTS

The surgical options available and the associated operative risks for repeat aortic valve replacement after freestanding homograft root repl acement with reimplantation of the coronary arteries are as yet undefi ned. We therefore reviewed our experience with repeat aortic valve rep lacement between January 1976 and July 1994 and identified 22 such pro cedures performed on 21 patients after homograft or autograft root rep lacement. Reoperation was indicated for structural deterioration in 16 and for bacterial endocarditis in 6 patients. Associated procedures w ere undertaken in 5 patients, and 4 procedures were performed emergent ly. Significant calcification of the homograft wall was noted in over half of all patients. There were no coronary ostial complications. In 13 patients new valves were inserted within the previous root: 9 mecha nical valves and 4 subcoronary homografts. In 9 patients the root was re-replaced. The mean crossclamp time was 85 (+/-20) minutes and mean cardiopulmonary bypass time was 123 (+/-32) minutes. There were no ear ly deaths and 5 late deaths. Two patients required reoperation for ble eding and 2 experienced low cardiac output syndromes postoperatively. Univariate analysis failed to identify any variables predictive of out come. We conclude that repeat aortic valve replacement after homograft root replacement even in the presence of significant calcification, c an be undertaken with an acceptable operative risk and should not be d elayed until irreversible ventricular dysfunction has occurred. The sa me options available at initial valve replacement may be employed at r eoperation, although extensive calcification mandates repeat root repl acement.