Long-term Outcomes of Reoperative Aortic Root Replacement

Hiroki Ikeuchi, Kozo Matsuo, Naoki Hayashida, Soichi Asano, Masashi Kabasawa, Shinichiro Abe, Hideomi Hasegawa, Takahiro Ito, Shintaro Koizumi, Hirokazu Murayama

Chiba Cardiovascular Center, Ichihara, Japan

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

【Objective】

As Valve-sparing root replacement (VSRR) increases, the discussion of its durability and safety of reoperation are more important. This study reviewed outcomes of patients undergoing reoperative aortic root replacement at our institution.

【Methods】

A retrospective review from 1994 to 2017, 69 patients underwent aortic root replacement. They were divided into a primary operation group (n=52) and a reoperation group (n=17). Cox proportional hazards regression analysis was used to identify risk factor for long-term mortality. The mean follow-up duration was 100.8 months.

【Results】

The mean age was 49.1 years. Sixty-seven patients (97.1%) underwent the Bentall procedure, and 13 (18.8%) patients had Marfan syndrome. Operative mortality was 2 (2.9%). There were no significant differences in baseline characteristics. The reoperation grounp had significantly longer cardiopulmonary bypass and cross-clamp times (p<0.01 for both). Operative mortality, postoperative stroke, reoperation for bleeding were similar between the groups. The 5-year survival (primary 98.1%, reoperation 80.7%; p=0.03) and 10-year survival (primary 92.6%, reoperation 80.7%; p=0.03) were significantly higher in the primary group. Multivariable analysis showed Marfan sydrome (hazard ratio 16.97, 95% confidence interval: 1.41 to 203.7, p=0.02) to be a risk factor for long-term mortality.

【Conclusion】

Reoperative aortic root replacement does not increase perioperative mortality or morbidity and have good overall long-term survival even in stronger operative stress. A statistically significant difference in long-term mortality may be related to have Marfan syndrome.