title: Early and long-term results of reoperative total aortic root replacement with reimplantation of the coronary arteries.
abstract: BACKGROUND
  Total root replacement with biologic valves and reimplantation of the coronaries gives good early and midterm results. There is continuing concern, however, regarding the risks and long-term results for reoperation after total replacement of the aortic root with reimplantation of the coronaries.
  
  
  METHODS
  Between June 1981 and July 2010, a total of 84 patients underwent reoperative aortic root replacement with reimplantation of the coronaries (60 male, mean age 38 ± 15 years). All patients had undergone first-time total aortic root replacement with homografts (82 patients) or autografts (2 patients). Indication for reoperation was structural valve deterioration in 72 patients (85%) and infective endocarditis in 12 patients (15%). Mean interval between first operation and reoperation was 11.1 ± 4.7 years (range, 1 month-24.7 years). Median length of follow-up was 9.7 ± 5.6 years (range, 1 month-24.4 years).
  
  
  RESULTS
  Thirty-day mortality was 2.4% (n = 2 patients). Both patients died postoperatively of low-output syndromes with multiorgan failure. At reoperation, 74 patients received homografts (87%), 7 patients underwent a Ross procedure (9%), and 3 received stentless porcine roots (4%). One patient required pacemaker implantation (1%). Actuarial survivals were 89% ± 4% and 81% ± 5% at 5 and 10 years, respectively. Nine patients underwent a successful third root replacement during follow-up. Freedom from third-time aortic root operation was 97% ± 3% at 10 years.
  
  
  CONCLUSIONS
  Reoperative aortic root replacement can be performed safely with good short-term and midterm outcomes in a young patient cohort.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.forename: Michael
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.forename: Herbert
authors.initials: H
authors.lastname: Witzke
authors.forename: Lucy
authors.initials: L
authors.lastname: Clark
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012092:Replantation; D055815:Young Adult