Re-do Aortic Root Replacement Has Comparable Morbidity and Mortality to New Aortic Root Replacement with Previous Sternotomy

P0274 

Abstract Submission 

Adam Carroll (1), Nicolas Chanes (1), Michal Schafer (1), Zihan Feng (1), Jintong Liu (1), Ananya Shah (1), Jacob Edwards (1), Muhammad Aftab (1), T. Brett Reece (1)

(1) University of Colorado Anschutz, Denver, CO

Adam Carroll    -  Contact Me
University of Colorado Anschutz

Nicolas Chanes    -  Contact Me
University of Colorado Anschutz

Michal Schafer    -  Contact Me
University of Colorado Anschutz

Zihan Feng    -  Contact Me
University of Colorado Anschutz

Jintong Liu    -  Contact Me
University of Colorado Anschutz

Ananya Shah    -  Contact Me
University of Colorado Anschutz

Jacob Edwards    -  Contact Me
University of Colorado Anschutz

*Muhammad Aftab    -  Contact Me
University of Colorado Anschutz

*T. Brett Reece    -  Contact Me
University of Colorado Anschutz

Adam Carroll    -  Contact Me
University of Colorado Anschutz

Objective
Aortic root replacement is commonly performed to address root pathology and is overall associated with low rates of morbidity and mortality. However, some prosthetic roots will degenerate requiring re-do replacement, or the prosthetic root will be afflicted with another pathology such as endocarditis or thrombosis. Aortic re-do root operations pose a significant technical challenge, and previous studies have sought to clarify associated perioperative outcomes. Most previous analyses have compared re-do root operations with de novo chests undergoing root replacement that have not had a previous operation. Comparisons with de novo chests have shown similar perioperative mortality rates; however, re-do roots have been associated with longer cardiopulmonary bypass and cross clamp times, and significant short-term morbidity. However, we believe that further investigation is necessary to compare true re-do roots (TRR) with patients undergoing re-do sternotomy who have not had a previous root replacement (no previous root, NPR). We sought to clarify outcomes comparing the two groups.
Methods
We performed a retrospective review of our database for patients who underwent aortic root replacement at our institution from 2009-2023. In total, 18 patients had a previous root operation and were undergoing a repeat root operation (true re-do root), and 76 patients had a previous sternotomy for a non-root operation and were undergoing root replacement (no previous root). Root replacement technique included Davids, Bentalls, BioBentalls, and Homograft procedures. Concomitant aortic procedures were considered and included as part of the analysis.

Results
No significant difference was found between baseline patient demographics and comorbidities. The majority of TRRs were urgent or emergent (55.6%), however this difference was not statistically significant compared to NPRs (p=0.290). TRRs were more likely have connective tissue disease (p=0.024), however the number of patients in each cohort was small. No differences were found in cardiopulmonary bypass, cross clamp, or circulatory arrest time. There was no significant difference in perioperative blood product administration, post-operative pacemaker rate, ICU-related complications, or mortality. There was no significant difference in ICU length of stay, however, TRRs had a longer overall hospital length of stay (p=0.028).

Conclusion
In patients with a non-native chest, outside of total length of stay, there is no difference in perioperative morbidity and mortality between TRRs and NPRs. If root intervention is potentially indicated at index operation, it should be performed without concern that re-do root replacement poses additional risk.

Aortic Root