title: Redo aortic root surgery for failure of an aortic homograft is a major technical challenge.
abstract: OBJECTIVE
  Aortic homografts offer many advantages over prosthetic valves. However, homograft dysfunction due to degeneration or infection may lead to reoperation. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge. To assess reoperation events a retrospective review was conducted.
  
  
  METHODS
  From January 2000 to October 2006, 20 consecutive patients (38.8+/-14.9 years old) underwent repeat surgery for aortic homograft failure.
  
  
  RESULTS
  Reoperation was performed 7.2+/-3.5 years after implantation of the aortic homograft as a root. Indication was homograft degeneration (n=18 [90%]) and endocarditis (n=2 [10%]). In patients with major homograft wall calcifications or endocarditis, nine aortic root reconstructions were performed (Bentall procedure n=7; homograft implantation n=2). Each homograft was dissected with electrical cauterization and removed 'en-bloc' sparing the coronary buttons. In case of flexible homograft wall, stented prostheses (mechanical n=10, bioprosthesis n=1) were implanted along the homograft annulus. Additional procedures consisted of mitral valve replacements (n=8), tricuspid repairs (n=4), Konno procedure (n=1) and coronary bypass (n=5). Perioperative complications occurred in seven (35%) patients: sternal re-entry accident (n=2); reoperations for mediastinitis (n=1) or bleeding (n=2); renal insufficiency (n=1); total heart block (n=1). No association was found between operative procedures and postoperative complications (Fisher's exact test). Two patients (10%) died from multiorgan failure in the early postoperative period. In total, 94.4% of the survivors remained free from reoperation at 74 months.
  
  
  CONCLUSIONS
  Reoperation on patients with an aortic homograft as a root presents a relatively high perioperative morbidity. The surgical strategy depends on the degree of homograft wall calcification.
authors.affiliation: Hôpital Bichat, Service de Chirurgie Cardiaque, 46 rue Henri Huchard, 75018 Paris, France. Thomas.joudinaud@bch.aphp.fr
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Joudinaud
authors.forename: Franck
authors.initials: F
authors.lastname: Baron
authors.forename: Richard
authors.initials: R
authors.lastname: Raffoul
authors.forename: Bruno
authors.initials: B
authors.lastname: Pagis
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.forename: Caroline
authors.initials: C
authors.lastname: Parisot
authors.forename: Ulrik
authors.initials: U
authors.lastname: Hvass
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Nataf
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery* / Q000637:transplantation; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome