Composite graft replacement of the aortic root after previous cardiac surgery: a 20-year experience.
BACKGROUND
An aging population and prolonged survival of patients after cardiac operations has meant that composite aortic root replacement after previous cardiac operation is being performed with increasing frequency.


METHODS
From January 1979 to July 1999, 32 patients underwent "reoperative" composite replacement of the aortic root at our institution. Previous operations were 16 aortic valve replacement, 9 coronary artery bypass grafting, 5 repair aortic dissection, and 7 others. Indications for operation included ascending aortic aneurysm in 16 patients, ascending aortic dissections in 10 patients, and other in 6 patients.


RESULTS
The unit elective mortality was 3 of 26 (11.5%). One surgeon's elective mortality was 1 of 22 (4.6%). The unit emergent mortality was 6 of 6 (100%). There has been one late death. Morbidity was low.


CONCLUSIONS
Reoperative aortic root replacement is a technically demanding procedure, but expertise in the area achieves low elective mortality. Consideration should be given to aortic root replacement at the initial procedure. Close follow-up of postcardiac operation patients is necessary to proceed with elective aortic root replacement if indicated. Emergent presentation in the reoperative setting has a very poor prognosis.
Vallely
M P
MP
Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.
Hughes
C F
CF
Bannon
P G
PG
Hendel
P N
PN
French
B G
BG
Bayfield
M S
MS
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D001026:Coronary Artery Bypass; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D012086:Reoperation