• Tirone E David, Christopher M Feindel, Joan Ivanov, and Susan Armstrong.
• Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca
• J Card Surg. 2004 Jul 1; 19 (4): 325-8.

ObjectiveThe objective was to review the operative risk and outcomes of redo aortic root replacement.Patients And MethodsFrom July 1990 to December 2001, aortic root replacement was performed in 165 patients who had at least one previous cardiac operation. Their mean age was 49 +/- 16 years and 78% were men. Twenty-eight patients had a previous aortic root replacement. The principal indication for surgery was prosthetic aortic valve dysfunction. All the patients had a dilated, calcified, ruptured, or some other abnormality of the aortic root. The follow-up was complete and extended from 0 to 12.5 years, mean of 3.8 years.ResultsThere were 12 operative (7%) and 20 late deaths (12%). The survival at 8 years was 68%+/- 6%. The principal cause of death was cardiovascular related. Age at increments of 5 years (risk ratio: 1.2; CI: 95%; 1.1 to 1.4) and preoperative New York Heart Association functional class IV (risk ratio: 2.2; CI: 95%: 1.1 to 4.7) were the only two independent predictors of death. Two patients had a stroke and died; two patients developed three episodes of prosthetic valve endocarditis and died. Three patients were reoperated on because of endocarditis in one, bioprosthetic valve failure in one, and dehiscence of a prosthetic mitral valve in one. The freedom from reoperation at 8 years was 93%+/- 5%.ConclusionsRedo aortic root replacement can be done with low operative mortality in elective patients and the risk increases in those who need emergent surgery and are older. The long-term results are satisfactory and similar to those for patients who have aortic root replacement for the first time.

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