Re-Operative Aortic Root Replacement In Patients With Prior Aortic Valve or Root Replacement: A Single Center Experience

P0275 

Abstract Submission 

Toyokazu Endo (1), Jaimin Trivedi (1), Priyadarshini Chandrashekhar (1), Michele Gallo (1), Erin Schumer (1), Brian Ganzel (1), Mark Slaughter (1), Siddharth Pahwa (1)

(1) University of Louisville School of Medicine, Louisville, KY

Toyokazu Endo    -  Contact Me
University of Louisville School of Medicine

Jaimin Trivedi    -  Contact Me
University of Louisville School of Medicine

Priyadarshini Chandrashekhar    -  Contact Me
University of Louisville School of Medicine

Michele Gallo    -  Contact Me
University of Louisville School of Medicine

Erin Schumer    -  Contact Me
University of Louisville School of Medicine

Brian Ganzel    -  Contact Me
University of Louisville School of Medicine

*Mark Slaughter    -  Contact Me
University of Louisville School of Medicine

Siddharth Pahwa    -  Contact Me
University of Louisville School of Medicine

Toyokazu Endo    -  Contact Me
N/A

Objectives: There are few studies that have evaluated the outcomes of patients undergoing a re-operative aortic root replacement after initial aortic valve replacement (AVR), or root surgery. The objective of this study was to evaluate the characteristics and outcomes of patients undergoing re-operative root replacement.

Methods: We evaluated a single-center cardiac surgery database from January 2014 to June 2023 to identify patients undergoing re-operative root replacement who had prior aortic valve, aortic root, ascending aortic, or any combination of these surgeries. Patients undergoing other prior cardiac procedures such as other valve repair/replacement, coronary artery bypass grafting, descending thoracic aortic surgery, or aortic arch surgery were excluded. Patient characteristics and outcomes were evaluated using descriptive statistics.

Results: A total of 59 patients (median age 63 years, 61% male) underwent re-operative root replacement during the study period after index aortic surgery. 49% had prior AVR, and 51% had prior root replacement. The indication for reoperation was predominantly due to new-onset aneurysm/pseudoaneurysm formation (39%), followed by degeneration of the initial prosthesis (34%) and endocarditis (27%). The median time between index surgery and reoperation was 8 (5-14) years. History of hypertension, type 2 diabetes, and prior MI were present in 81%, 20%, and 20% of patients, respectively. Median left ventricular ejection fraction was 55% (50-60) and creatinine was 1.0 mg/dl (0.8-1.4). The operative mortality was 6.4%, and the incidence of complications such as stroke, reoperation for bleeding, and renal failure were 3.4%, 7.1%, and 3.4%, respectively. Of 59 patients, 43 were seen again at a 1-year follow-up (median follow-up 2.5 years). One patient did require a late pacemaker placement, and none required a cardiac re-operation.

Conclusions: This single-center experience shows that re-operative aortic root replacement after prior AVR or root replacement is associated with acceptable early and mid-term mortality. No patients required late re-reoperations for the ascending aorta. Re-operative aortic root replacement may be a safe procedure for a select group of patients. A larger collaborative cohort may identify risk factors for adverse operative outcomes.

Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)