Feasibility and Safety Outcomes after Reoperation on the Aortic Root: 20 Years Experience of a Single Center

Background: In the past decade aortic surgery has evolved from being a high-risk intervention to a standardized elective operation with satisfying outcome and adequate survival rates. With the increase of safety of the aortic surgery, the number of patients reaching a senior age is growing and with that also the reoperation rate increases. Our goal with this study was to evaluate feasibility and to identify risk factors for adverse outcome after reoperation of the aortic root.

Methods: Patients who received a reoperation on the aortic root between 1999 and 2023 after an operation on the thoracic aorta with or without aortic valve replacement were included in this study. Exclusion criteria were age under 18 and transcatheter aortic valve implantation as first operation.

Results: A total of 192 patients were analyzed. Diagnosis for reoperation as dilatation (p = 0.03), rupture or endoleak (p ≤ 0.004), endocarditis (p = 0.02), combined intervention of the aortic root and arch (p = 0.048), and concomitant procedures at reoperation (p = 0.003) showed lower overall survival. The mean time to reoperation was 2.1 (0.36–9.90) years. 30-day mortality was 13%. The survival at 1, 5, and 10 years were 84, 81, and 71%, respectively. In the Cox analysis age (HR = 1.10, p = 0.02), dilatation at reoperation (HR = 9.88, p = 0.02), bleeding after reoperation (HR = 54.37, p = 0.01), temporary mechanical circulatory support after reoperation (HR = 79.05, p = 0.01), and a combined procedure on the aortic root and arch (HR = 10.35, p = 0.03) have a significantly higher incidence of death. The ROC analysis showed that age over 60 years at reoperation is a significant risk factor for adverse outcome (AUC = 0.712, p ≤ 0.001).

Conclusion: The mortality after reoperation on the aortic root is primarily driven by pre- and perioperative events. Risk factors for adverse outcome are age over 60 years, female gender, non-elective operations, combination of aortic root and arch procedures, and concomitant procedures at reoperation. Predictors of mortality independently of multiple cofounders are bleeding complications, temporary mechanical circulatory support, and combined procedure of aortic root and aortic arch.

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Artikel online veröffentlicht:
11. Februar 2025