Reoperations on the ascending aorta and aortic root. Early and late results?
OBJECTIVE
We have retrospectively evaluated our results after aortic root and ascending aorta reoperations to determine risk factors of early death and late mortality.


METHODS
From January 1986 to April 2002, 73 patients underwent ''reoperative'' procedures on the aortic root and the ascending aorta. The mean age was 56.1+/-13.4 years and males numbered 62 (84.9%). The most frequent indication for reoperation was degenerative aortic aneurysm (49.3%) followed by post-dissection aneurysm (11%). Aortic root replacement with composite valve graft was performed in 47 patients (64.4%) and with aortic homograft in 2 (2.7%). Nineteen patients (26%) underwent ascending aorta replacement with tubular graft, and 4 (5.5%) underwent tailoring aortoplasty of the ascending aorta.


RESULTS
The 30-day mortality rate was 16.4% (12 patients). Mortality following elective operations was 8%, and that following urgent or emergency operations was 34.8% (p=0.002). Late survival of hospital survivors at 1, 5 and 10 years was 93.8%, 77.7% and 37%, respectively. In the multivariate Cox regression analysis chronic renal failure (p=0.003) and urgent or emergency operation (p=0.018) were found to be independent predictors of late mortality.


CONCLUSIONS
Reoperations on the ascending aorta can be accomplished with acceptable early mortality and satisfactory long-term


RESULTS
More radical treatment of the aortic pathology at the initial operation may reduce the need for further reoperations. A careful follow-up is extremely important for detecting complications of the first operation or progression of the aortic pathology before an emergency operation, predictive of poorer early and late outcome, is needed.
Pacini
D
D
Department of Cardiac Surgery, University of Bologna, Bologna, Italy. dpacini@hotmail.com
Di Marco
L
L
Loforte
A
A
Angeli
E
E
Dell'amore
A
A
Bergonzini
M
M
Di Bartolomeo
R
R
D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome