Redo aortic root replacement: Experience with 31 patients

Background. Aortic root re-replacement is being performed with increased fr equency. Limited information is available regarding the surgical approaches and clinical outcomes of this reoperation. Methods. Between May 1980 and May 1999, 31 patients (mean age, 45 +/- 15 ye ars) underwent redo composite replacement of the aortic valve and ascending aorta. Indications for reoperation were prosthetic valve endocarditis in 1 2 patients (39%), failed biological valve in 17 (55%), and false aneurysm i n 2 (6%). At reoperation, mechanical valves were implanted in 24 patients a nd biologic valves in 7. All patients with endocarditis had annular abscess and required reconstruction of the left ventricular outflow tract before i mplantation of a new valved conduit. Mechanical valves were used in 24 pati ents, aortic homograft in 4, and bioprosthetic valves in 3. The coronary bu tton technique was used to reimplant the coronary arteries whenever possibl e. Extension of one or both coronary arteries with a short segment of saphe nous vein or a synthetic graft was used in 16 patients 152%). The aortic ar ch was replaced in 7 patients (23%). Results. There was one operative death (3%) because of rupture of an abdomi nal aortic aneurysm. The mean follow-up was 47 +/- 46 months and was 100% c omplete. There were five late deaths (16%), three of which were cardiac rel ated. The actuarial survival was 71% +/- 12% at 5 years. Three patients exp erienced recurrent prosthetic valve endocarditis 4 months to 8 years after operation. The 8-year freedom from endocarditis for patients operated on fo r endocarditis was 82% +/- 11% compared with 100% for those operated on for other reasons (p = 0.1). At the last follow-up, 21 of 25 survivors (84%) w ere in New York Heart Association functional classes I or II, and 4 were in class III. Conclusions. Redo aortic root replacement can be performed with good early and late results. Patients operated on for prosthetic root endocarditis may have an increased risk of recurrent late endocarditis. (Ann Thorac Surg 20 01;71:1460-3) (C) 2001 by The Society of Thoracic Surgeons.