Reoperative aortic root replacement: Outcome in a contemporary series

Esaki, Jiro; Leshnower, Bradley G.; Binongo, José; Lasanajak, Yi; McPherson, LaRonica; Thourani, Vinod H.; Chen, Edward P.

doi:10.1016/j.jtcvs.2017.04.084

Cited by 24 publications

(31 citation statements)

References 16 publications

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“…In this regard, the studies presenting precise data of location and extension of periannular complications invariably report the need for complex root surgery in case of larger abscess cavities, involvement of aorto-mitral continuity or circular detachment of the aorta (3,4,13). An early mortality rate around 20% can be expected in these cases (3)(4)(5)7,(13)(14)(15). Surgical complexity accounts partially for this finding since patients with aortoventricular discontinuity present usually in a poor clinical condition, with signs of heart failure and sepsis.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve endocarditis complicated by proximal false aneurysm

Malvindi

Mikus

Caprili³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Aortic valve endocarditis remains a life-threatening condition, especially in cases of periannular complications. Aorto-ventricular discontinuity associated with proximal false aneurysm represents a severe picture caused by extensive tissue disruption and is usually associated with prosthetic valve infection. Complex surgical repair is required in these cases and continues to be associated with high mortality and morbidity rates.Methods: We retrieved information for 32 patients undergoing operation for infective aortic valve/ prosthetic valve endocarditis complicated by pseudoaneurysm arising from aorto-ventricular discontinuity.Patients were relatively young, mostly male and most of them had a prior cardiac operation. Aortic root replacement with valve graft conduit was performed in all cases; it was associated with other procedures in seven patients: CABG (n=2), MV surgery (n=3), MV surgery + CABG (n=1) and pulmonary valve replacement (n=1). We reported and analysed patient outcomes at early and mid-term follow-up.Results: Pre-discharge mortality was 22% (n=7). The postoperative course was complicated in 24 (75%) cases. Eighteen patients (56%) sustained low cardiac output resulting in multiple organ failure syndrome and death in five cases. One patient (3%) experienced a major neurologic deficit with a permanent cerebral stroke. Acute kidney injury complicated the course in 12 cases (37%), continuous renal replacement therapy was necessary in four patients (12%). Overall survival and freedom from endocarditis and reoperation at 5-year was 59% and 89%, respectively. Conclusions:Patients with complicated aortic valve endocarditis presented generally in a poor preoperative state. Surgical treatment poses a non-negligible risk of postoperative mortality and morbidity but provides an acceptable survival rate and a satisfactory recovery at mid-term.

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Section: Discussionmentioning

confidence: 99%

Aortic valve endocarditis complicated by proximal false aneurysm

Malvindi

Mikus

Caprili³

et al. 2019

Ann. Cardiothorac. Surg.

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“…In a series of patients undergoing redo root replacement and concomitant procedures, mortality was reported at 14%. 7 These series together suggest that while reoperative proximal thoracic aortic surgical patients, even in the best of hands, face considerable mortality risk, overall mortality is acceptable and improved with experience. In our study, the overall in-hospital mortality was 12%, which is within the range of most published reports of redo proximal thoracic aortic surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 2 3 Several institutions have reported their outcomes in this reoperative proximal aortic surgical population, with some referral centers reporting operative mortality as low as 4%, while others report mortality as high as 19%. 4 5 6 7 8 9 10 11 12 13 14 15 Anecdotally, higher volume centers experience lower mortality, although the relationship between surgical volume and mortality in this complex surgical population remains largely unexamined.…”

Section: Introductionmentioning

confidence: 99%

Higher Institutional Volume Reduces Mortality in Reoperative Proximal Thoracic Aortic Surgery

et al. 2020

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Objective This study aims to determine the impact of institutional volume on mortality in reoperative proximal thoracic aortic surgery patients using national outcomes data. Methods The Nationwide Inpatient Sample was queried from 1998 to 2011 for patients with diagnoses of thoracic aneurysm and/or dissection who underwent open mediastinal repair. A total of 103,860 patients were identified. A total of 1,430 patients had prior cardiac surgery. Patients were further stratified into groups by institutional aortic volume: low (<12 cases/year), medium (12–39 cases/year), and high (40+ cases/year) volume. Multivariable risk-adjusted analysis accounting for emergent status and aortic dissection among other factors was performed to determine the impact of institutional volume on mortality. Results Overall mortality was 12% in the reoperative population. When the redo cohort was divided into tertiles, high-volume group had a 5% operative mortality compared with 9 and 15% for the medium- and low-volume groups, respectively. Multivariable analysis revealed that patients operated on at low- (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 2.6–9.6, p < 0.001) and medium-volume centers (OR = 2.1, 95% CI: 1.1–4.2, p = 0.03) had higher odds of mortality when compared with patients operated on at high-volume centers. Conclusions High-volume aortic centers can significantly reduce mortality for reoperative aortic surgery, compared with lower volume institutions.

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“…From a more global perspective, Erisaki and colleagues 5 confirm surgical wisdom, which says that the risk of a procedure generally correlates with its complexity. Selected reports from selected surgeons or groups sometimes give us the impression of low risk and lead to more liberal decisions in favor of complex operations.…”

mentioning

confidence: 96%

“…Erisaki and colleagues 5 shed different light on this topic and should lead to more caution. The authors analyzed 280 patients, qualifying as high volume center.…”

mentioning

confidence: 99%