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Fudulu DP, Dong T, Kota R, Sinha S, Chan J, Rajakaruna C, Dimagli A, Angelini GD, Ahmed EM. In-hospital outcomes predictors and trends of redo sternotomy aortic root replacements: insights from a UK registry analysis. Front Cardiovasc Med 2024; 10:1295968. [PMID: 38259318 PMCID: PMC10801157 DOI: 10.3389/fcvm.2023.1295968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Redo sternotomy aortic root surgery is technically demanding, and the evidence on outcomes is mostly from retrospective, small sample, single-centre studies. We report the trend, early clinical results and outcome predictors of redo aortic root replacement over 20 years in the United Kingdom. Methods We retrospectively analysed collected data from the UK National Adult Cardiac Surgery Audit (NACSA) on all redo sternotomy aortic root replacements performed between 30th January 1998 and 19th March 2019. We analysed trends in the volume of operations, characteristics of hospital survivors vs. non-survivors, and predictors of in-hospital outcomes. Results During the study period, 1,107 redo sternotomy aortic root replacements were performed (median age 59, 26% of patients were females). Eighty-four per cent of cases (N = 931) underwent a composite root replacement, 11% (N = 119) had homograft root replacement and valve-sparing root replacement was performed in 5.1% (N = 57) of cases. There was a steady increase in the volume of redo sternotomy root replacements beyond 2006, from an annual volume of 22 procedures in 2006 to 106 procedures in 2017. Hospital mortality was 17% (n = 192), postoperative stroke or TIA occurred in 5.2% (n = 58), and postoperative dialysis was required in 11% (n = 109) of patients. Return to the theatre for bleeding/tamponade was required in 9% (n = 102) and median in-hospital stay was 9 days. Age >59 (OR: 2.99, CI: 1.92-4.65, P < 0.001), recent myocardial infarction (OR: 6.42, CI: 2.24-18.41, P = 0.001) were associated with increased in-hospital mortality. Emergency surgery (OR: 3.95, 2.27-6.86, P < 0.001), surgery for endocarditis (OR: 2.05, CI: 1.26-3.33, P = 0.001), salvage coronary artery bypass grafting (OR: 2.20, CI: 1.37-3.54, P < 0.001), arch surgery (OR: 2.47, CI: 1.30-3.61, P = 0.018) and aortic cross-clamp longer than 169 min (OR: 2.17, CI: 1.00-1.01, P = 0.003) were associated with increased risk of mortality. We found no effect of the centre or surgeon volume on mortality (P > 0.05). Conclusions Redo sternotomy aortic root replacement still carries significant morbidity and mortality and is sporadically performed across surgeons and centres in the UK.
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Affiliation(s)
- Daniel P. Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Rahul Kota
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Cha Rajakaruna
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni D. Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Eltayeb Mohamed Ahmed
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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3
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De Palo M, Scicchitano P, Malvindi PG, Paparella D. Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis. Antibiotics (Basel) 2021; 10:antibiotics10010050. [PMID: 33419074 PMCID: PMC7825452 DOI: 10.3390/antibiotics10010050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/25/2020] [Accepted: 01/03/2021] [Indexed: 12/25/2022] Open
Abstract
The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Enterococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE).
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Affiliation(s)
- Micaela De Palo
- Section of Cardiac Surgery, A.O.U. Consorziale Policlinico di Bari, 70124 Bari, Italy
- Correspondence: (M.D.P.); (D.P.); Tel.: +39-080-559-4404 (M.D.P.); +39-080-919-9162 (D.P.)
| | - Pietro Scicchitano
- Section of Cardiology, F. Perinei Hospital, Altamura, 70022 Bari, Italy;
| | | | - Domenico Paparella
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy
- Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, Italy
- Correspondence: (M.D.P.); (D.P.); Tel.: +39-080-559-4404 (M.D.P.); +39-080-919-9162 (D.P.)
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Shea NJ, D'Angelo AM, Polanco AR, Allen P, Sanchez JE, Kurlansky P, Patel VI, Takayama H. Higher Institutional Volume Reduces Mortality in Reoperative Proximal Thoracic Aortic Surgery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2020; 8:59-65. [PMID: 33152786 PMCID: PMC7644294 DOI: 10.1055/s-0040-1713860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective
This study aims to determine the impact of institutional volume on mortality in reoperative proximal thoracic aortic surgery patients using national outcomes data.
Methods
The Nationwide Inpatient Sample was queried from 1998 to 2011 for patients with diagnoses of thoracic aneurysm and/or dissection who underwent open mediastinal repair. A total of 103,860 patients were identified. A total of 1,430 patients had prior cardiac surgery. Patients were further stratified into groups by institutional aortic volume: low (<12 cases/year), medium (12–39 cases/year), and high (40+ cases/year) volume. Multivariable risk-adjusted analysis accounting for emergent status and aortic dissection among other factors was performed to determine the impact of institutional volume on mortality.
Results
Overall mortality was 12% in the reoperative population. When the redo cohort was divided into tertiles, high-volume group had a 5% operative mortality compared with 9 and 15% for the medium- and low-volume groups, respectively. Multivariable analysis revealed that patients operated on at low- (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 2.6–9.6,
p
< 0.001) and medium-volume centers (OR = 2.1, 95% CI: 1.1–4.2,
p
= 0.03) had higher odds of mortality when compared with patients operated on at high-volume centers.
Conclusions
High-volume aortic centers can significantly reduce mortality for reoperative aortic surgery, compared with lower volume institutions.
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Affiliation(s)
- Nicholas J Shea
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
| | - Alex M D'Angelo
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
| | - Antonio R Polanco
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
| | - Philip Allen
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
| | - Joseph E Sanchez
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
| | - Paul Kurlansky
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
| | - Virendra I Patel
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
| | - Hiroo Takayama
- Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York
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5
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Zhou Z, Liang M, Huang S, Wu Z. Reimplantation versus remodeling in valve-sparing surgery for aortic root aneurysms: a meta-analysis. J Thorac Dis 2020; 12:4742-4753. [PMID: 33145047 PMCID: PMC7578473 DOI: 10.21037/jtd-20-1407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Valve-sparing aortic root replacement (VSARR), which includes reimplantation and remodeling techniques, has been developed as an important treatment for aortic root aneurysms. We aimed to evaluate the outcomes of reimplantation versus remodeling techniques in valve-sparing surgery for aortic root aneurysms. Methods A systematic review and meta-analysis was performed by searching PubMed, Embase and the Cochrane Library until November 2019. Fourteen retrospective cohort studies comparing reimplantation with remodeling techniques for aortic root aneurysms were included and contained at least one of the following outcomes: early mortality, late mortality, aortic valve-related reoperation, and postoperative moderate to severe aortic regurgitation (AR). Results The outcomes of 1,672 patients (1,011 underwent reimplantation surgery, and 661 underwent remodeling) were analyzed. Compared with remodeling, the reimplantation technique was associated with a significantly lower risk of late mortality (RR =0.34; 95% CI, 0.17–0.71; P=0.004; I2=37%) and reoperation (RR =0.31; 95% CI, 0.12–0.76; P=0.01; I2=55%). There was no significant difference in early mortality (RR =0.69; 95% CI, 0.31–1.53; P=0.36; I2=0%), postoperative moderate to severe AR (RR =0.64; 95% CI, 0.31–1.32; P=0.22; I2=36%) or postoperative stroke (RR =1.26; 95% CI, 0.58–2.75; P=0.56; I2=0%) between the two groups. No evidence of publication bias was detected. Conclusions The current meta-analysis indicate that patients who undergo reimplantation procedures have a significantly lower risk of late mortality and reoperation than those who undergo remodeling procedures. Early mortality, postoperative moderate to severe AR and stroke were comparable between the two techniques.
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Affiliation(s)
- Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Mengya Liang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Suiqing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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6
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Kaskar A, Bohra DV, Rao K R, Shetty V, Shetty D. Primary or secondary Bentall-De Bono procedure: are the outcomes worse? Asian Cardiovasc Thorac Ann 2019; 27:271-277. [PMID: 30776904 DOI: 10.1177/0218492319832775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to compare the outcomes of a primary and secondary Bentall-De Bono procedure. METHODS From 2008 to 2015 (8-year period), 308 patients underwent a Bentall-De Bono procedure in our institute. The mean age was 43 ± 13 years and 80% were men. Twenty-eight patients had prior cardiac surgery through a median sternotomy (group 1) and 280 underwent a primary Bentall-De Bono procedure (group 2). Various preoperative and perioperative parameters were analyzed before and after propensity-score matching. RESULTS Before propensity-score matching, patients undergoing a secondary Bentall-De Bono procedure had a worse preoperative profile, as indicated by a higher EuroSCORE II ( p < 0.0001), with hospital mortality in group 1 of 14% (4/28) and 5% (14/280) in group 2 ( p = 0.069). After propensity-score matching, there was no significant difference in EuroSCORE II ( p = 0.922) or hospital mortality ( p = 0.729). After adjusting for the different variables, repeat sternotomy could not be identified as an independent predictor of postoperative mortality or morbidity. Survival at the end of 1 and 5 years in both groups showed no significant differences before or after propensity-score matching ( p = 0.328 and p = 0.356, respectively). In Cox multivariable regression analysis, reoperation was not identified as an independent factor for survival before ( p = 0.559) or after propensity-score matching ( p = 0.365). CONCLUSION A secondary Bentall-De Bono procedure can be performed with acceptable mortality and morbidity, and with midterm survival rates comparable to those of a primary Bentall-De Bono procedure.
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Affiliation(s)
- Ameya Kaskar
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Deepak V Bohra
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Rahul Rao K
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Varun Shetty
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Devi Shetty
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
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7
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Maroto LC, Carnero M, Cobiella J, García M, Vilacosta I, Reguillo F, Villagrán E, Olmos C. Reoperation for composite valve graft failure: Operative results and midterm survival. J Card Surg 2018; 33:330-336. [PMID: 29726041 DOI: 10.1111/jocs.13710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The replacement of a failed composite valve graft is technically more demanding and is associated with increased morbidity and mortality. We present our technique and outcomes for reoperations for composite graft failures. METHODS Between September 2011 and June 2017, 14 patients underwent a redo composite graft replacement. Twelve patients (85.7%) were male, and mean age was 58.4 years ± 12 standard deviation (SD). One patient had two previous root replacements. Indications for reoperation were endocarditis (8), aortic pseudoaneurysm (3), and aortic prosthesis thrombosis (3). Mean logistic EuroSCORE and EuroSCORE II were 30.8% and 14.7%, respectively. RESULTS A mechanical composite graft was used in 12 patients and biological composite grafts were used in two patients. Hospital mortality was 14.3% (n = 2). One patient (7.1%) required reoperation for bleeding, One patient (7.1%) had mechanical ventilation >24 h, and four patients (28.6%) required implantation of a permanent pacemaker. Median intensive care unit and hospital stays were 3 days (interquartile range [IQR] 1-5) and 10 days (IQR 6.5-38.5). One patient experienced recurrent prosthetic valve endocarditis 14 months after operation. On follow-up, 11 of 12 survivors were in New York Heart Association class I or II. Survival at 3 years was 85.7% ± 9.4% SD. CONCLUSIONS Composite valve graft replacement can be performed with acceptable morbidity and mortality with good mid-term survival.
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Affiliation(s)
- Luis C Maroto
- Department of Cardiac Surgery, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
| | - Javier Cobiella
- Department of Cardiac Surgery, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
| | - Mónica García
- Department of Cardiac Surgery, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Reguillo
- Department of Cardiac Surgery, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
| | - Enrique Villagrán
- Department of Cardiac Surgery, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
| | - Carmen Olmos
- Department of Cardiology, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain
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8
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Esaki J, Leshnower BG, Binongo JN, Lasanajak Y, McPherson L, Thourani VH, Chen EP. Reoperative aortic root replacement: Outcome in a contemporary series. J Thorac Cardiovasc Surg 2017; 154:800-808.e3. [DOI: 10.1016/j.jtcvs.2017.04.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/01/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
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9
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Berretta P, Di Marco L, Pacini D, Cefarelli M, Alfonsi J, Castrovinci S, Di Eusanio M, Di Bartolomeo R. Reoperations versus primary operation on the aortic root: a propensity score analysis. Eur J Cardiothorac Surg 2017; 51:322-328. [PMID: 28186292 DOI: 10.1093/ejcts/ezw250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/09/2016] [Accepted: 06/22/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paolo Berretta
- Division of Cardiac Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Luca Di Marco
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | | | - Marco Di Eusanio
- Division of Cardiac Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Roberto Di Bartolomeo
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
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10
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Iribarne A, Keenan J, Benrashid E, Wang H, Meza JM, Ganapathi A, Gaca JG, Kim HW, Hurwitz LM, Hughes GC. Imaging Surveillance After Proximal Aortic Operations: Is it Necessary? Ann Thorac Surg 2016; 103:734-741. [PMID: 27677566 DOI: 10.1016/j.athoracsur.2016.06.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Current guidelines for imaging surveillance after proximal aortic repair are not evidence based. This study sought to characterize the incidence and causes of reintervention after proximal aortic operations to provide data to guide the frequency and duration of postoperative surveillance. METHODS Data on all patients undergoing proximal aortic operations (ascending, with or without root, with or without aortic valve replacement, or with or without arch) during a 9-year period (n = 869) at a single institution were prospectively collected. Patients who required reintervention on the proximal or distal aorta were identified and causes for reintervention determined. Planned two-stage repairs and index procedures done at other hospitals were excluded. The primary end point was the time to the first reintervention, and competing-risk Cox regression was used to model reintervention risk. RESULTS Reinterventions occurred in 4.3% of patients (n = 37), with 48.6% (n = 18) involving the proximal aorta and 51.4% (n = 19) the distal. Median time to reintervention was 2.8 years (interquartile range, 1.5 to 3.6 years). For index aneurysm cases, reintervention for aneurysm of the descending/thoracoabdominal aorta and root were most common. Of the 6 root aneurysms/pseudoaneurysms, 5 (83%) were due to degeneration of a stentless porcine aortic root. For index type A dissections, reintervention for aneurysm of the descending/thoracoabdominal aorta and arch were most common. The mean duration of follow up was 4.2 ± 2.5 years. The 9-year actuarial freedom from reintervention was 92.9%. Cox regression showed index type A dissection was a significant predictor of time to aortic reintervention (hazard ratio, 2.01; 95% confidence interval, 1.04 to 3.9; p = 0.038). CONCLUSIONS Reinterventions after proximal aortic operations are uncommon; most occur within 3 years of the index operation and involve the proximal and distal aorta nearly equally. Patients with type A dissection or stentless porcine roots require aggressive surveillance, whereas a more liberal approach is suitable for patients without such risk factors. This strategy may reduce the lifetime radiation burden and health care costs.
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Affiliation(s)
- Alexander Iribarne
- Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jeffrey Keenan
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Hanghang Wang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - James M Meza
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Asvin Ganapathi
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Han W Kim
- Division of Cardiology, Duke Cardiovascular Magnetic Resonance Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lynne M Hurwitz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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Chong BK, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:250-7. [PMID: 27525233 PMCID: PMC4981226 DOI: 10.5090/kjtcs.2016.49.4.250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 11/16/2022]
Abstract
Background Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). Methods We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. Results Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. Conclusion Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.
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Affiliation(s)
- Byung Kwon Chong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Liebrich M, Weimar T, Tzanavaros I, Roser D, Doll KN, Hemmer WB. The David Procedure for Salvage of a Failing Autograft After the Ross Operation. Ann Thorac Surg 2014; 98:2046-52. [DOI: 10.1016/j.athoracsur.2014.06.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/14/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022]
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13
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Bashir M, Fok M, Shaw M, Field M, Kuduvalli M, Desmond M, Harrington D, Rashid A, Oo A. Liverpool Aortic Surgery Symposium V: New Frontiers in Aortic Disease and Surgery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:100-9. [PMID: 26798724 DOI: 10.12945/j.aorta.2014.13-051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
Aortic aneurysm disease is a complex condition that requires a multidisciplinary approach in management. The innovation and collaboration among vascular surgery, cardiothoracic surgery, interventional radiology, and other related specialties is essential for progress in the management of aortic aneurysms. The Fifth Liverpool Aortic Surgery Symposium that was held in May 2013 aimed at bringing national and international experts from across the United Kingdom and the globe to deliver their thoughts, applications, and advances in aortic and vascular surgery. In this report, we present a selected short synopsis of the key topics presented at this symposium.
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Affiliation(s)
- Mohamad Bashir
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Michael Desmond
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Abbas Rashid
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Fukunaga N, Koyama T, Konishi Y, Murashita T, Kanemitsu H, Okada Y. Clinical outcome of redo operation on aortic root. Gen Thorac Cardiovasc Surg 2013; 62:215-20. [PMID: 24136125 DOI: 10.1007/s11748-013-0332-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/09/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND With the increasing use of biologic conduits or bioprosthetic valve, the number of patients who require redo operation on aortic root increased. METHODS In the past 22 years, 14 patients underwent redo operation on aortic root. The mean age was 61.9 ± 14.8 years. Previous operations were full root replacement with stentless valve (n = 4), aortic root replacement with subcoronary technique (n = 3) and Bentall operation (n = 7). The operation interval was 5.4 ± 6.4 years. Indication for redo operation included structural valve deterioration (n = 6), prosthetic valve endocarditis (n = 4), perivalvular leakage (n = 2), dilatation of sinus of Valsalva (n = 1) and dehiscence of proximal anastomosis line (n = 1). Mean follow-up period was 5.3 ± 5.2 years. RESULTS Present operations were full root replacement with stentless valve (n = 5) and Bentall operation (n = 9). There was one in-hospital death (7.1 %) caused by arrhythmia. Postoperative complications included implantation of permanent pacemaker (n = 3), arrhythmia (n = 2) and re-intubation (n = 1). The 5-year survival was 92.9 ± 6.9%. Freedom from redo aortic operation at 5 years was 100%. CONCLUSION Redo operation on aortic root can be performed with acceptable in-hospital mortality and good late survival.
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Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan,
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Preisman S, Shinfeld A, Raanani E. Safe approach for chest reentry in a patient with large pseudoaneurysm of ascending aorta facilitated by intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth 2013; 28:709-13. [PMID: 24016687 DOI: 10.1053/j.jvca.2013.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sergey Preisman
- Department of Anesthesiology and Intensive Care, Sheba Medical Center (affiliated with Sackler School of Medicine, Tel Aviv University), Tel Hashomer, Israel.
| | - Amihay Shinfeld
- Department of Cardiac Surgery, Sheba Medical Center (affiliated with Sackler School of Medicine, Tel Aviv University), Tel Hashomer, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Sheba Medical Center (affiliated with Sackler School of Medicine, Tel Aviv University), Tel Hashomer, Israel
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Malvindi PG, van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation After Acute Type A Aortic Dissection Repair: A Series of 104 Patients. Ann Thorac Surg 2013; 95:922-7. [DOI: 10.1016/j.athoracsur.2012.11.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/09/2012] [Accepted: 11/13/2012] [Indexed: 11/30/2022]
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Di Bartolomeo R, Berretta P, Petridis FD, Folesani G, Cefarelli M, Di Marco L, Di Eusanio M. Reoperative surgery on the thoracic aorta. J Thorac Cardiovasc Surg 2013; 145:S78-84. [DOI: 10.1016/j.jtcvs.2012.11.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 08/13/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
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Abstract
Marfan syndrome is associated with a high incidence of aortic root aneurysm and life-threatening aortic dissection. With the successful use of surgical aortic root replacement, dissection-related mortality has been significantly reduced. We present the case of a patient with Marfan syndrome who presented with heart failure secondary to an unusual graft-related complication 14 years after a Bentall procedure. Investigations revealed a supra-aortic stenosis resulting from a kink in the Bentall graft caused by pressure from an expanding aortic arch aneurysm. The patient underwent surgery with improvement in his ejection fraction and heart failure symptoms.
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Gatti G, Moncada A, Minati A, Pappalardo A. Replacement of a stented biologic prosthesis within an aortic valved conduit. Ann Thorac Surg 2012; 93:e53-5. [PMID: 22365015 DOI: 10.1016/j.athoracsur.2011.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 09/28/2011] [Accepted: 10/14/2011] [Indexed: 10/28/2022]
Abstract
A 68-year-old man was referred for severe aortic regurgitation 10 years after aortic root replacement with a valved conduit containing a stented bioprosthesis that had been sutured inside of the vascular tube graft, rather than at its extremity. Because of this simple modification of the Bentall concept, replacing the prosthetic valve within the aortic conduit was easy and uneventful.
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Affiliation(s)
- Giuseppe Gatti
- Division of Cardiac Surgery, Cardiovascular Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste, Italy.
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Replacement of the Infected Composite Aortic Root Prosthesis. Ann Thorac Surg 2011; 92:1651-5. [DOI: 10.1016/j.athoracsur.2011.05.115] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 11/15/2022]
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Secure anastomosis for damaged aortic root reconstruction: Graft insertion technique. J Thorac Cardiovasc Surg 2011; 142:948-50. [DOI: 10.1016/j.jtcvs.2011.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/15/2011] [Accepted: 02/25/2011] [Indexed: 11/23/2022]
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Early and long-term results of reoperative total aortic root replacement with reimplantation of the coronary arteries. J Thorac Cardiovasc Surg 2011; 142:1473-7. [PMID: 21555137 DOI: 10.1016/j.jtcvs.2011.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 03/15/2011] [Accepted: 04/06/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Total root replacement with biologic valves and reimplantation of the coronaries gives good early and midterm results. There is continuing concern, however, regarding the risks and long-term results for reoperation after total replacement of the aortic root with reimplantation of the coronaries. METHODS Between June 1981 and July 2010, a total of 84 patients underwent reoperative aortic root replacement with reimplantation of the coronaries (60 male, mean age 38 ± 15 years). All patients had undergone first-time total aortic root replacement with homografts (82 patients) or autografts (2 patients). Indication for reoperation was structural valve deterioration in 72 patients (85%) and infective endocarditis in 12 patients (15%). Mean interval between first operation and reoperation was 11.1 ± 4.7 years (range, 1 month-24.7 years). Median length of follow-up was 9.7 ± 5.6 years (range, 1 month-24.4 years). RESULTS Thirty-day mortality was 2.4% (n = 2 patients). Both patients died postoperatively of low-output syndromes with multiorgan failure. At reoperation, 74 patients received homografts (87%), 7 patients underwent a Ross procedure (9%), and 3 received stentless porcine roots (4%). One patient required pacemaker implantation (1%). Actuarial survivals were 89% ± 4% and 81% ± 5% at 5 and 10 years, respectively. Nine patients underwent a successful third root replacement during follow-up. Freedom from third-time aortic root operation was 97% ± 3% at 10 years. CONCLUSIONS Reoperative aortic root replacement can be performed safely with good short-term and midterm outcomes in a young patient cohort.
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Di Eusanio M, Berretta P, Bissoni L, Petridis FD, Di Marco L, Di Bartolomeo R. Re-operations on the proximal thoracic aorta: results and predictors of short- and long-term mortality in a series of 174 patients. Eur J Cardiothorac Surg 2011; 40:1072-6. [DOI: 10.1016/j.ejcts.2011.02.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 02/03/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022] Open
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Malvindi PG, van Putte BP, Leone A, Heijmen RH, Schepens MAAM, Morshuis WJ. Aortic reoperation after freestanding homograft and pulmonary autograft root replacement. Ann Thorac Surg 2011; 91:1135-40. [PMID: 21353201 DOI: 10.1016/j.athoracsur.2011.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/03/2011] [Accepted: 01/04/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human allografts and pulmonary autografts offer many advantages as an aortic valve and root substitute. The progressive degeneration of the aortic allograft and the pulmonary autograft has been seen as an important disadvantage, and the need for a reoperation has been perceived as challenging and risky for the patients. METHODS Between March 1992 and October 2009, 53 consecutive patients (mean age 50 ± 13 years; 38 male), who had a previous aortic root replacement, underwent redo surgery for failure of the aortic homograft (n = 42) or the pulmonary autograft (n = 11). The median follow-up (available for 47 of 51 patients) was 44 months. RESULTS Structural valve deterioration was the main indication for reoperation on the homograft (86%), with an earlier presentation in patients who received homografts from donors more than 55 years old. Failure of the pulmonary autograft occurred primarily because of severe aortic regurgitation predominantly due to dilation of the autograft (n = 5) and autograft valve prolapse (n = 5). The total in-hospital mortality was 3.8% (n = 2). No deaths occurred among patients who previously underwent a Ross procedure. The course was complicated in 25 cases (48%). The cumulative 1-year, 5-year, and 8-year survival rates were 92%, 90%, and 77%, respectively. No late deaths were encountered after reoperation on the pulmonary autograft (maximum follow-up 218 months). Freedom from reoperation (excluding early in-hospital operation) for recurrent aortic valve or root pathology was 97% at 8 years. CONCLUSIONS Reoperation after freestanding homograft and pulmonary autograft root replacement can be accomplished safely. The total postoperative morbidity rate is still high.
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Affiliation(s)
- Pietro G Malvindi
- Department of Cardiac Surgery, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
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Bekkers J, Klieverik L, Raap GB, Takkenberg J, Bogers A. Aortic root reoperations after pulmonary autograft implantation. J Thorac Cardiovasc Surg 2010; 140:S58-63; discussion S86-91. [DOI: 10.1016/j.jtcvs.2010.07.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/23/2010] [Accepted: 07/30/2010] [Indexed: 11/29/2022]
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Malvindi PG, van Putte BP, Heijmen RH, Schepens MAAM, Morshuis WJ. Reoperations for aortic false aneurysms after cardiac surgery. Ann Thorac Surg 2010; 90:1437-43. [PMID: 20971235 DOI: 10.1016/j.athoracsur.2010.06.103] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/17/2010] [Accepted: 06/22/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aortic false aneurysm is a rare complication after cardiac surgery. Aortic dissection, infection, arterial wall degeneration, and poor surgical technique are recognized as risk factors for the occurrence of postsurgical false aneurysm. Despite some recent reports about percutaneous false aneurysm exclusion, a complex surgical reoperation is needed in most of the cases. METHODS We retrospectively reviewed our experience in 43 patients who received a reoperation for postsurgical aortic false aneurysm in the last 14 years. Thirty-three patients were male. The mean age was 60 ± 12 years. Most of the patients received prior aortic surgery on the aortic root, the ascending aorta, the aortic arch, and the descending thoracic aorta (38 patients). False aneurysm was diagnosed during follow-up evaluation in the absence of any symptoms in 23 cases. Univariate and multivariate analyses on 18 perioperative variables were performed. RESULTS In-hospital mortality was 6.9% (3 patients). The postoperative course was complicated in 17 cases (39%). At multivariate analysis, a preoperative history of coronary artery disease and postoperative sepsis were independent risk factors for hospital mortality. Survival rates at 1, 5, and 10 years were 94%, 79%, and 68%, respectively. Freedom from reoperation was 86% at 1 year and 72% at 5 and 10 years. CONCLUSIONS Despite a high postoperative complication rate, a reoperation for postsurgical aortic false aneurysm can be performed with acceptable mortality and good mid-term and long-term outcomes.
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Affiliation(s)
- Pietro G Malvindi
- Department of Cardiac Surgery, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
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Silva J, Maroto LC, Carnero M, Vilacosta I, Cobiella J, Villagrán E, Rodríguez JE. Ascending Aorta and Aortic Root Reoperations: Are Outcomes Worse Than First Time Surgery? Ann Thorac Surg 2010; 90:555-60. [DOI: 10.1016/j.athoracsur.2010.03.092] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/29/2010] [Accepted: 03/29/2010] [Indexed: 11/30/2022]
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