Aortic root reoperation: a technical challenge

Abstract

Background and aim of the study: It is well known that aortic root re-replacement presents a formidable technical challenge. Thus, the study aim was to describe the authors' experience with this high-risk cohort.

Methods: Between August 1996 and January 2009, a total of 26 patients (mean age 51 years; range: 16-72 years) underwent aortic root re-replacement surgery at the authors' institution. Previous aortic root operations included mechanical valved conduit (n = 9), tissue valved conduit (n = 5), Ross procedure (n = 4), homograft (n = 4), David procedure (n = 2) and Yacoub procedure (n = 2). The indications for surgery included endocarditis (n = 16), Ross procedure failure (n = 4), valve degeneration (n = 3), anastomotic aneurysm (n = 2), and severe valve insufficiency (n = 1).

Results: The reoperations performed were classified as follows: aortic homograft (n = 11), mechanical conduit (n = 9), tissue valved conduit (n = 4) and David procedure (n = 2). The mean cardiopulmonary bypass time was 219 min (range: 101-398 min), and the mean cross-clamp time 142 min (range: 89-253 min). The mean ICU stay was 8 days (range: 1-45 days), and the mean hospital stay 20 days (range: 3-64 days). Four rethoracotomies were performed for postoperative bleeding or tamponade (14%). Two patients (8%) died within 30 days of surgery, and three (12%) required pacemaker implantation due to atrioventricular block (grade III).

Conclusion: Aortic root reoperation, even in the setting of endocarditis, can be carried out with excellent results. The major goals of this concept include a clinical examination and preoperative diagnosis, in addition to computed tomography to identify possible pitfalls during re-sternotomy. Care must also be taken to provide adequate myocardial and organ protection, by utilizing blood cardioplegia and individual selective perfusion techniques.