Abstract 20791: An Evaluation of Re-Replacement of the Aortic Root with Coronary Reimplantation
Background: Total aortic root replacement with coronary reimplantation provides good early- and mid-term results for patients with aortic valve disease. However, there is continuing concern about the management of late structural valve deterioration (SVD) which could necessitate re-replacement of the root. The aims of this study were to evaluate the short and long-term results of re-replacement of the root with coronary reimplantation.
Methods: From 1981 and 2005, 82 patients (60 males; 39 ± 5 years) underwent redo aortic root replacement with coronary reimplantation. All patients had undergone first time total aortic root replacement using homografts (80 patients) or autografts (2 patients). Indication for reoperation was SVD in 70 patients (85%) and infective endocarditis in 12 patients (15%). Direct reimplantation of the coronary arteries was possible in all cases with careful mobilization. Mean interval between first operation and reoperation was 11 ± 5 years (range 49 days – 25 years). Mean length of follow-up after reoperation was 9.3 ± 5.9 years.
Results: Thirty-day mortality was 2.4% (n=2). Both patients were operated urgently following late presentations in heart failure. The cause of death was low output syndromes with multi-organ failure in both cases. At reoperation, 72 patients received homografts (87%), 7 patients underwent a Ross procedure (9%), and 3 received stentless xenograft roots (4%). Actuarial survival is 87 ± 4% and 79 ± 5% at 5 and 10 years, respectively. Seven patients underwent successful third operation during follow-up at 11 ± 4 years after second operation (SVD: n=6 and endocarditis: n=1). Freedom from third time aortic root reoperation is 100% and 97 ± 3% at 5 and 10 years, respectively. Thus, actuarial survival free from reoperation is 88 ± 5% and 78 ± 5% at 5 and 10 years, respectively (Figure).
Conclusion: Re-replacement of the root with coronary reimplantation can be performed safely with no accelerated rejection when an allograft is used.
- © 2010 by American Heart Association, Inc.