کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5992821 | 1578712 | 2006 | 8 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta](/preview/png/5992821.png)
BackgroundAortic root replacement after a previous operation on the aortic valve, aortic root, or ascending aorta remains a major challenge.MethodsRecords of 56 consecutive patients (44 men; mean age, 56.4 ± 13.6 years) undergoing reoperative aortic root replacement between June 1994 and June 2005 were reviewed retrospectively.ResultsReoperation was performed 9.4 ± 6.7 years after the last cardiac operation. Indications for reoperation were true aneurysm (n = 14 [25%]), false aneurysm (n = 10 [18%]), dissection or redissection (n = 9 [16%]), structural or nonstructural valve dysfunction (n = 10 [18%]), prosthetic valve-graft infection (n = 12 [21%]), and miscellaneous (n = 1 [2%]). Procedures performed were aortic root replacement (n = 47 [84%]), aortic root replacement plus mitral valve procedure (n = 5 [9%]), and aortic root replacement plus arch replacement (n = 4 [7%]). In 14 (25%) patients coronary artery bypass grafting had to be performed unexpectedly during the same procedure or immediately after the procedure to re-establish coronary perfusion. Hospital mortality reached 17.9% (n = 10). Multivariate logistic regression analysis revealed the need for unplanned perioperative coronary artery bypass grafting as the sole independent risk factor for hospital death (P = .005). Actuarial survival was 83.8% ± 4.9% at 1 month, 73.0% ± 6.3% at 1 year, and 65.7% ± 9.0% at 5 years after the operation. One patient had recurrence of endocarditis 6.7 months after the operation and required repeated homograft aortic root replacement.ConclusionReoperative aortic root replacement remains associated with a high postoperative mortality. The need to perform unplanned coronary artery bypass grafting during reoperative aortic root replacement is a major risk factor for hospital death. The optimal technique for coronary reconstruction in this setting remains to be debated.
Journal: The Journal of Thoracic and Cardiovascular Surgery - Volume 131, Issue 3, March 2006, Pages 601-608