HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giovanni Battista Luciani Giuseppe Faggian Alessandro Mazzucco Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Luciani, G. B. Articles by Mazzucco, A. Search for Related Content PubMed PubMed Citation Articles by Luciani, G. B. Articles by Mazzucco, A.

Eur J Cardiothorac Surg 2000;17:602-607
© 2000 Elsevier Science NL

Predicting outcome after reoperative procedures on the aortic root and ascending aorta

Division of Cardiac Surgery, University of Verona, O.C.M. Piazzale Stefani 1, Verona 37126, Italy

Corresponding author. Tel.: +39-45-807-2485; fax: +39-45-807-3308
e-mail: luciani{at}netbusiness.it

Objective: Reoperations on the ascending aorta after prior aortic procedures are formidable challenges. In order to identify factors predictive of clinical outcome using a uniform surgical approach, results of a 15-year experience were reviewed. Methods: Between 1983 and 1998, 78 reoperations on the ascending aorta were performed in 71 consecutive patients. There were 56 males and 15 females, aged 54±13 years (10–73 years), with a mean interval to first reoperation of 60±76 months (5–223 months). The original operation was replacement of ascending aorta (23), aortic valve (25), aortic root (7), ascending aorta with valve preservation (9), ascending aorta and aortic valve (7). Surgical approach included femoral vessels dissection and repeat sternotomy, with femoro-femoral bypass limited to cases of traumatic reentry. Reoperation consisted in replacement of the aortic root (48), ascending aorta (15), ascending aorta and aortic valve (6), aortic root with ascending aorta and arch (6), ascending aorta and aortic arch (3). Average aortic crossclamp and cardiopulmonary bypass times were 122±86 and 188±60 min, respectively. Results: Early deaths were five (7%), due to low output syndrome (3), hemorrhage (1) and sepsis (1). Mortality for emergent reoperation was significantly higher (38 vs. 3%, P=0.001). A total of 39 early complications were observed in 78 reinterventions (50%), including: traumatic reentry requiring emergent femoro-femoral bypass (4), reexploration for bleeding (4), respiratory failure (12), sepsis (5), transient neurologic dysfunction (4), renal failure (3), myocardial infarction (3), circulatory insufficiency requiring mechanical life support (2), and wound infection (2). Average intensive care unit stay was 4.5±9.7 days (0.5–40 days). Survival was 92±4%, 78±10% and 78±10% at 1, 5, and 10 years, respectively. At follow-up (mean 34±36 months, 1–170), survivors were in satisfactory clinical conditions (1.6±0.8 mean NYHA class, 1–3) with no evidence of renal, respiratory or neurologic dysfunction. Multivariable analysis showed emergent reoperation (P=0.001), prior aortic valve replacement (P=0.005) and need for arch replacement (P=0.03) to be predictive of higher operative mortality. Longer duration of bypass (P=0.01) and aortic arch replacement (P=0.04) were predictive of higher prevalence of postoperative complications. Conclusions: Reoperations on the ascending aorta via repeat sternotomy without preventive femoral bypass are associated with low operative risk and high prevalence early complications. Emergent reintervention due to aortic dissection, particularly in patients with prior aortic valve replacement, and need for arch repair are predictive of poorer perioperative outcome. Long-term outlook of hospital survivors is satisfactory.

Key Words: Aortic aneurysm • Aortic dissection • Aortic root replacement • Endocarditis • Ascending aorta replacement • Reoperation

This article has been cited by other articles:

				T. Tsunekawa, H. Ogino, H. Matsuda, K. Minatoya, H. Sasaki, J. Kobayashi, T. Yagihara, and S. Kitamura Composite Valve Graft Replacement of the Aortic Root: Twenty-Seven Years of Experience at One Japanese Center Ann. Thorac. Surg., November 1, 2008; 86(5): 1510 - 1517. [Abstract] [Full Text] [PDF]

				D. R. Brinster, R. J. Rizzo, and R. M. Bolman III Ascending Aortic Aneurysms Card. Surg. Adult, January 1, 2008; 3(2008): 1223 - 1250. [Full Text]

				Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 601 - 608.

				G. B. Luciani, A. Favaro, F. Viscardi, P. Bertolini, and A. Mazzucco Valve-sparing root replacement for pulmonary autograft dissection late after the Ross operation J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 753 - 756. [Full Text] [PDF]

				C. A. Anderson, R. J. Rizzo, and L. H. Cohn Ascending Aortic Aneurysms Card. Surg. Adult, January 1, 2003; 2(2003): 1123 - 1148. [Full Text]

				S. A. LeMaire, D. J. DiBardino, C. Koksoy, and J. S. Coselli Proximal aortic reoperations in patients with composite valve grafts Ann. Thorac. Surg., November 1, 2002; 74(5): S1777 - 1780. [Abstract] [Full Text] [PDF]