Reoperation after aortic root replacement and its impact on long-term survivalCentral MessagePerspective
Elizabeth L. Norton, MD,
Parth M. Patel, MD,
Yanhua Wang, PhD,
Jose Binongo, PhD,
Dov Levine, MD,
Sameer Singh, MD,
Shreya Chodisetty, BA,
Oreoluwa E. Olakunle, MD,
Bradley G. Leshnower, MD,
Hiroo Takayama, MD,
Edward P. Chen, MD
Affiliations
Elizabeth L. Norton, MD
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
Parth M. Patel, MD
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
Yanhua Wang, PhD
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga; Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga; Section of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
Jose Binongo, PhD
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga; Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga; Section of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
Dov Levine, MD
Section of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
Sameer Singh, MD
Section of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
Shreya Chodisetty, BA
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
Oreoluwa E. Olakunle, MD
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
Bradley G. Leshnower, MD
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
Hiroo Takayama, MD
Section of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
Edward P. Chen, MD
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; Address for reprints: Edward P. Chen, MD, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC 27710.
Objective: Reoperation after aortic root replacement (ARR) is associated with increased operative risk and complexity. This study evaluated clinical outcomes and reoperation rates in patients undergoing ARR. Methods: From 2004 to 2021, 2700 adult patients underwent an ARR in a 2-institution database. Among 2542 surviving patients, 705 patients who had a history of previous cardiac surgery as well as 11 patients who underwent transcatheter aortic valve replacement after index ARR were excluded. Among the finalized cohort of 1826 patients, 88 (4.8%) underwent a reoperation (REDO) on the aortic valve or proximal aorta (root/ascending) a mean of 3.1 years after index ARR whereas 1738 (95%) did not undergo reoperation (no-REDO). A subgroup analysis was performed among those undergoing reoperation by indication including valve dysfunction (48%), endocarditis/graft infection (33%), and aortic aneurysm/dissection/rupture (12%). Reoperative indication was unknown in 6 patients (7%). Results: The REDO group was younger at time of index ARR (52 vs 58 years, P < .0001) and had more bicuspid aortic valves (56% vs 37%, P = .0003). Most patients underwent modified Bentall ARR (61%), whereas 38% underwent a valve-sparing root replacement. Index root operations were similar between groups. At time of reoperation, 53% underwent aortic valve replacement and 35% underwent redo root replacement. Long-term survival was similar between REDO and no-REDO groups (80% vs 85%, P = .26) and reoperation was not a risk factor for late mortality (hazard ratio, 1.31; P = .26); however, REDO ARR was a risk factor for late mortality (hazard ratio, 2.41; P = .02). Conclusions: The incidence of aortic valve and/or proximal aorta reoperation after index ARR is relatively low at 4.8%; however, root reoperation is a risk factor for late mortality.
