title: [Reoperative aortic root replacement: short- and long-term outcomes in 111 patients].
abstract: BACKGROUND
  The aim of this study was to report results of aortic root reoperations and to identify predictors of in-hospital and long-term mortality.
  
  
  METHODS
  Between 1986 and 2011, 111 consecutive patients (mean age 55.4 years, 85 male [76.6%]) were reoperated on the aortic root after previous aortic surgery at our institution. An urgent/emergent operation was performed in 24 patients (21.6%). Indications for reoperation were degenerative aneurysm (n = 56), chronic post-dissection aneurysm (n = 27), active prosthetic infection (n = 14), false aneurysm (n = 10) and acute dissection (n = 4). Surgical procedures were limited to the aortic root in 68 patients (61.3%), and involved the entire proximal thoracic aorta in 43 patients (38.7%).
  
  
  RESULTS
  In-hospital mortality was 12.6%, being 6.9% and 33.3% in elective and urgent cases, respectively (p=0.002). On multivariate analysis, cardiopulmonary bypass time (odds ratio 1.029/min; p=0.011) and urgent/emergent status (odds ratio 8.486; p=0.044) were independent predictors of in-hospital mortality. Follow-up was 99.1% complete. Estimated 1-, 5-, and 10-year survival rates were 82.5%, 71.9% and 50.6%, respectively. Six redo procedures were performed during follow-up. Freedom from reoperation at 1, 5, and 10 years was 100%, 91.7% and 86.1%, respectively. On Cox regression analysis, chronic aortic dissection (hazard ratio 21.2; p=0.009) was an independent predictor of reintervention at follow-up.
  
  
  CONCLUSIONS
  Reoperation on the aortic root can be performed with acceptable mortality and good mid- and long-term outcomes, in particular when carried out on an elective basis. Cardiopulmonary bypass time and urgent/emergent status remain the most important risk factors for reduced survival in aortic surgery.
authors.affiliation: Universita degli Studi, Policlinico S.Orsola-Malpighi, Bologna. marco.dieusani2@unibo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Paolo
authors.initials: P
authors.lastname: Berretta
authors.forename: Mariano
authors.initials: M
authors.lastname: Cefarelli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Folesani
authors.forename: Francesco Dimitri
authors.initials: FD
authors.lastname: Petridis
authors.forename: Luca
authors.initials: L
authors.lastname: Di Marco
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017541:Aneurysm, False / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000601:surgery; D012086:Reoperation; D015203:Reproducibility of Results; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome