Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement

Abstract

Background: There are limited data regarding the clinical outcomes of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement (AVR). We aimed to analyze outcomes of reoperative aortic root or ascending aorta replacement after prior AVR. Methods: Eighty patients with prior AVR underwent reoperative aortic root or ascending aorta replacement in our hospital. The indications were root or ascending aortic aneurysm in 36 patients, root or ascending aortic dissection in 37, root false aneurysm in 2, prosthesis valve endocarditis (PVE) with root abscess in 2, Behçet's disease (BD) with root destruction in 3 patients. An elective surgery was performed in 63 patients and an emergent surgery in 17. The survival and freedom from aortic events during the followup were evaluated with the Kaplan-Meier survival curve and the log-rank test. Results: The operative techniques included ascending aorta replacement in 14 patients, ascending aorta replacement with AVR in 3, prosthesis-sparing root replacement (PSRR) in 35, Bentall procedure in 24, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/80). A composite of adverse events occurred in 5 patients, including 1 operative death, 2 stroke and 3 renal failure necessitating hemodialysis. The mean follow-up was 35.5±22.1 months. Five late deaths occurred. The Kaplan-Meier survival at 1 year, 3 years and 6 years were 97.5%, 91.1% and 84.1%, respectively. Aortic events developed in 3 patients. The freedom from aortic events at 1-year, 3-year, and 6-year were 100%, 96.3% and 88.9%, respectively. There were no differences in survival and freedom from aortic events between the elective group and the emergent group. Conclusions: Reoperative aortic root or ascending aorta replacement after prior AVR could be performed to treat the root or ascending pathologies after AVR, with satisfactory early and midterm outcomes.

The surgical outcomes of aortic valve replacement in patients with aortic valve lesions caused by Behcet’s disease: lessons we learned

“…In this study, for patients undiagnosed preoperatively, PVL occurred in 10 patients (87.7%). We also found that in our study as well as others, aortic root or ascending aorta replacement after a prior AVR resulted in a higher morbidity and mortality rate (15,16).…”

“…To solve these problems, modified total aortic root replacement (5) and the Modified Bentall procedure (16) have been tried by some surgeons. For example, Ando and Liang put Teflon felt outside the aortic root to prevent tearing of the anastomosis (6)(7)(8).…”

Does the residual aorta dilate after replacement of the bicuspid aortic valve and ascending aorta?

“…On stratification with higher and lower expansion rate, the baseline diameters were substantially linked with diameters at late follow-up as indicated by the generalized linear estimate, but the time-scaled multilevel analysis could not discover any time-dependent dilatation. We considered that the operation changed the eccentric jet and as such, reduced the shear stress on the aortic wall ( 8 , 33 , 34 ). We also investigated the impact of CMN grade on the change in the residual aortic diameter and revealed that patients with a larger DAAo expansion had a higher CMN grade, but did not observe any association between high-grade CMN and progression of the SOV and DAAo dilatation.…”