Surgical strategy and clinical outcomes of reoperative aortic root replacement after prior aortic valve replacement
- VernacularTitle:主动脉瓣置换术后二次主动脉根部置换术的手术策略和临床结果
- Author:
Yaojun DUN
1
;
Yi SHI
1
;
Hongwei GUO
1
;
Bo WEI
1
;
Yizhen WEI
1
;
Xiangyang QIAN
1
;
Xiaogang SUN
1
;
Cuntao YU
1
Author Information
1. Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China
- Publication Type:Journal Article
- Keywords:
Aortic valve replacement;
aortic root replacement;
aortic dissection;
aortic root aneurysm;
reoperation
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(01):113-120
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the surgical strategy of reoperative aortic root replacement after prior aortic valve replacement (AVR), and analyze the early and mid-term outcomes. Methods From April 2013 to January 2020, 75 patients with prior AVR underwent reoperative aortic root replacement in Fuwai Hospital. There were 54 males and 21 females with a mean age of 56.4±12.7 years. An emergent operation was performed in 14 patients and an elective operation in 61 patients. The indications were aortic root aneurysm in 38 patients, aortic dissection involving aortic root in 30 patients, root false aneurysm in 2 patients, prosthesis valve endocarditis with root abscess in 2 patients, and Behçet's disease with root destruction in 3 patients. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test. Results The operative procedures included prosthesis-sparing root replacement in 45 patients, Bentall procedure in 26 patients, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/75). A composite of adverse events occurred in 5 patients, including operative death (n=1), stroke (n=1), and acute renal injury necessitating hemodialysis (n=3). The follow-up was available for all 74 survivors, with the mean follow-up time of 0.5-92.0 (30.3±25.0) months. Four late deaths occurred during the follow-up. The survival rate at 1 year, 3 years and 6 years was 97.2%, 91.4% and 84.4%, respectively. Aortic events developed in 2 patients. The rate of freedom from aortic events at 1 year, 3 years, and 6 years was 98.7%, 95.0% and 87.7%, respectively. There was no difference in rate of survival or freedom from aortic events between the elective patients and the emergent patients. Conclusion Reoperative aortic root replacement after prior AVR can be performed to treat the root pathologies after AVR, with acceptable early and mid-term outcomes.
