title: Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta.
abstract: BACKGROUND
  Aortic root replacement after a previous operation on the aortic valve, aortic root, or ascending aorta remains a major challenge.
  
  
  METHODS
  Records of 56 consecutive patients (44 men; mean age, 56.4 +/- 13.6 years) undergoing reoperative aortic root replacement between June 1994 and June 2005 were reviewed retrospectively.
  
  
  RESULTS
  Reoperation was performed 9.4 +/- 6.7 years after the last cardiac operation. Indications for reoperation were true aneurysm (n = 14 [25%]), false aneurysm (n = 10 [18%]), dissection or redissection (n = 9 [16%]), structural or nonstructural valve dysfunction (n = 10 [18%]), prosthetic valve-graft infection (n = 12 [21%]), and miscellaneous (n = 1 [2%]). Procedures performed were aortic root replacement (n = 47 [84%]), aortic root replacement plus mitral valve procedure (n = 5 [9%]), and aortic root replacement plus arch replacement (n = 4 [7%]). In 14 (25%) patients coronary artery bypass grafting had to be performed unexpectedly during the same procedure or immediately after the procedure to re-establish coronary perfusion. Hospital mortality reached 17.9% (n = 10). Multivariate logistic regression analysis revealed the need for unplanned perioperative coronary artery bypass grafting as the sole independent risk factor for hospital death (P = .005). Actuarial survival was 83.8% +/- 4.9% at 1 month, 73.0% +/- 6.3% at 1 year, and 65.7% +/- 9.0% at 5 years after the operation. One patient had recurrence of endocarditis 6.7 months after the operation and required repeated homograft aortic root replacement.
  
  
  CONCLUSIONS
  Reoperative aortic root replacement remains associated with a high postoperative mortality. The need to perform unplanned coronary artery bypass grafting during reoperative aortic root replacement is a major risk factor for hospital death. The optimal technique for coronary reconstruction in this setting remains to be debated.
authors.affiliation: Department of Chirurgie Thoracique et Cardiovasculaire, Hôpital Henri Mondor, Créteil, France. matthias.kirsch@hmn.aphp.fr
authors.forename: E W Matthias
authors.initials: EW
authors.lastname: Kirsch
authors.forename: N Costin
authors.initials: NC
authors.lastname: Radu
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso-Dessap
authors.forename: Marie-Line
authors.initials: ML
authors.lastname: Hillion
authors.forename: Daniel
authors.initials: D
authors.lastname: Loisance
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects