Reoperations on the ascending aorta and aortic root: pitfalls and results in 134 patients.
BACKGROUND
This analysis was performed to evaluate the results of reoperations 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 analyzed. Indications for reintervention were a true or false aneurysm (35%), acute dissection (3.0%), aortic valve stenosis and/or insufficiency (23.1%), prosthetic valve endocarditis (32.8%), and combinations (4.5%). The principal reoperations performed were aortic root replacement (composite graft, freestyle, aortic allograft, or pulmonary autograft) in 116 patients, ascending aortic replacement in 10 patients, and closure of a false aneurysm in 5 patients. 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 micromol/L (p = 0.001), acute aortic dissection (p = 0.001), intraoperative technical problems (p = 0.001), and postoperative dialysis (p = 0.001). Freedom from repetitive reoperation was 99% at 1 year and 98% at 5 and 10 years.


CONCLUSIONS
Reoperations on the aortic root and ascending aorta can be performed with an early mortality which is very acceptable.
Schepens
M A
MA
Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. marc.schepens@worldonline.nl
Dossche
K M
KM
Morshuis
W J
WJ
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D017541:Aneurysm, False / Q000401:mortality / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate