Aortic root surgery in patients with previous aortic root or valve operations

OBJECTIVES: To assess the operative indication, risk factors, procedures, and outcomes of aortic root surgery in patients with previous aortic root or valve surgery. PATIENTS AND METHODS: Between 1995 and 2007, aortic root surgery was performed in 137 patients. Thirty-five of those, who had previous root replacement, root remodeling or aortic valve surgery, were evaluated retrospectively. RESULTS: Indications for redo surgery included lesions at coronary artery reconstruction site after root procedures, aneurysmal formation or dissection of sinus Valsalva after aortic valve procedures, and prosthetic material infection. Two cases with prior graft infection died of sepsis, and one case with extended aortic dissection died of esophageal bleeding. Hospital mortalities were, hence, 8.6% in redo cases, which was comparable to 5.0% in primary root surgery cases. Multivariate risk factor analysis of root surgery revealed that preceding infective aortic root lesion was the only significant independent risk factor for postoperative mortality, whereas redo procedure per se was not a significant risk. CONCLUSIONS: Redo aortic root surgery can be performed with a reasonably low operative risk. Graft infection in patients with previous aortic root surgery remains a challenging lesion.