Reoperations on the ascending aorta and aortic root: Pitfalls and results in 134 patients

Background. This analysis was performed to evaluate the results of reoperat ions on the ascending aorta and aortic root. Methods. All reoperations (n = 134) on the aortic root and ascending aorta performed between February 1981 and April 1998 were retrospectively analyze d. Indications for reintervention were a true or false aneurysm (35%), acut e dissection (3.0%), aortic valve stenosis and/or insufficiency (23.1%), pr osthetic valve endocarditis (32.8%), and combinations (4.5%). The principal reoperations performed were aortic root replacement (composite graft, free style, aortic allograft, or pulmonary autograft) in 116 patients, ascending aortic replacement in 10 patients, and closure of a false aneurysm in 5 pa tients. Results were analyzed using univariate statistical methods. Results. Hospital mortality was 6.6% (8 patients). Univariate predictors of hospital death were preoperative functional class III or IV (p = 0.02), an interval of less than 6 months between the primary and actual operation (p = 0.02), preoperative creatinine level of more than 200 mu mol/L (p = 0.00 1), acute aortic dissection (p = 0.001), intraoperative technical problems (p = 0.001), and postoperative dialysis (p = 0.001). Freedom from repetitiv e reoperation was 99% at 1 year and 98% at 5 and 10 years. Conclusions. Reoperations on the aortic root and ascending aorta can be per formed with an early mortality which is very acceptable. (C) 1999 by The So ciety of Thoracic Surgeons.