PMID- 17954067
OWN - NLM
STAT- MEDLINE
DCOM- 20071108
LR  - 20071023
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 84
IP  - 5
DP  - 2007 Nov
TI  - Reoperative aortic root replacement in patients with previous aortic surgery.
PG  - 1592-8; discussion 1598-9
AB  - BACKGROUND: Reoperative aortic root reconstruction is increasingly performed and 
      remains a clinical challenge. The aim of this study is to evaluate the outcome of 
      patients undergoing reoperative aortic root replacement after previous aortic 
      surgery. METHODS: From 1995 to 2006, 156 consecutive patients underwent 
      reoperative aortic root replacement after previous aortic valve replacement 
      (group 1, n = 106, 67.8%), proximal aortic reconstruction (group 2, n = 25, 
      16.1%), and aortic root replacement (group 3, n = 25, 16.1%). Their records were 
      retrospectively reviewed. RESULTS: The mean age was 58.1 +/- 14.4 years, and 
      73.7% (n = 115) were men. Reoperation was performed 98.4 months after previous 
      operation, with 14.7% (n = 23) having undergone three or more sternotomies. 
      Indications for reoperations were endocarditis in 55 (35.3%), prosthetic valve 
      dysfunction in 28 (17.9%), paravalvular leak in 12 (7.7%), aortic aneurysm or 
      pseudoaneurysm in 29 (18.5%), aortic dissection in 12 (7.7%), and aortic stenosis 
      or insufficiency in 20 (12.9%). Aortic root replacement was performed in all 156 
      patients, with concomitant hemiarch reconstruction in 62 (39.7%), Cabrol coronary 
      reconstruction in 5 (3.2%), coronary artery bypass grafting (CABG) in 26 (16.6%), 
      and mitral valve repair or replacement (MVR) in 25 (16.0%). Thirty-day mortality 
      was 11.5% (n = 18). Actuarial survival was 86.4% +/- 2.7% at 1 year, 72.6% +/- 
      4.3% at 5 years, and 58.4% +/- 7.8% at 10 years. Subgroup analysis demonstrated 
      no difference in 30-day mortality (group 1, 14.1%; group 2, 8.0%; group 3, 4.0%; 
      p = 0.31) and late survival between the three groups (p = 0.14). Multivariate 
      analysis demonstrated age older than 75 years (p = 0.03) and New York Heart 
      Association (NYHA) functional class IV (p = 0.05) as risk factors for 30-day 
      mortality. CONCLUSIONS: Reoperative aortic root reconstruction can be performed 
      with a low perioperative mortality rate and satisfactory long-term survival. Age 
      older than 75 years and NYHA class IV are risk factors for early mortality. 
      Previous aortic root replacement is not a risk factor for reoperative aortic root 
      reconstruction.
FAU - Szeto, Wilson Y
AU  - Szeto WY
AD  - Division of Cardiovascular Surgery, Department of Surgery, University of 
      Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA. 
      szetow@uphs.upenn.edu
FAU - Bavaria, Joseph E
AU  - Bavaria JE
FAU - Bowen, Frank W
AU  - Bowen FW
FAU - Geirsson, Arnar
AU  - Geirsson A
FAU - Cornelius, Katherine
AU  - Cornelius K
FAU - Hargrove, W Clark
AU  - Hargrove WC
FAU - Pochettino, Alberto
AU  - Pochettino A
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aorta/*surgery
MH  - Aortic Valve/*surgery
MH  - Cardiopulmonary Bypass
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/etiology
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2007/10/24 09:00
MHDA- 2007/11/09 09:00
CRDT- 2007/10/24 09:00
PHST- 2007/01/26 00:00 [received]
PHST- 2007/05/18 00:00 [revised]
PHST- 2007/05/21 00:00 [accepted]
PHST- 2007/10/24 09:00 [pubmed]
PHST- 2007/11/09 09:00 [medline]
PHST- 2007/10/24 09:00 [entrez]
AID - S0003-4975(07)01143-5 [pii]
AID - 10.1016/j.athoracsur.2007.05.049 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2007 Nov;84(5):1592-8; discussion 1598-9. doi: 
      10.1016/j.athoracsur.2007.05.049.