 |
|
| Reoperative Aortic Root and Transverse Arch Procedures: A Contemporary Comparison of Redo and Primary Operations |
|
Back to 86th Annual Meeting Back to Program Outline OBJECTIVE: Risk factors affecting outcome following replacement of the ascending aorta and transverse arch after previous proximal cardioaortic surgery have not been clearly defined. METHODS: 201 patients (138 male, mean age 60.1±15 yrs) underwent aortic root (100) or transverse arch (101) reoperations at our institution (01/98-12/04) after 1.3 ± 0.7 previous cardioaortic procedures (range 1-6). The median interval to reoperation (yrs) was 11.4 after aortic valve surgery, 5.5 after CABG, 7.0 after proximal aortic surgery and 6.2 after other cardioaortic surgery. Pts presented with chronic aortic dissection (67), degenerative (47) or atherosclerotic (32) aneurysms, aortic valve dysfunction (37), endocarditis (9) and acute dissection (3). A comparison group (479 pts; 323 m; 62.4 ± 15.9 yrs), who underwent primary root (335) and transverse arch (144) procedures (1/98-12/04), did not differ significantly with regard to history of hypertension, CAD, COPD, diabetes, gender, ejection fraction (EF) and urgency, but had a higher incidence of aortic dilatation and a higher mean age. RESULTS: In the redo group, overall hospital mortality was 8.5% (17 pts), and did not differ significantly between root• (7 pts, 7.0%) and archΔ procedures (10 pts, 9.9%; p≥0.45; see figure). Among primary procedures, hospital mortality was higher for arch Λ (13 pts, 9.0%) than for root ° (10 pts, 2.9%) operations (p≤.01; figure). There was no significant difference in hospital mortality between primary and redo arch surgery (p≥0.8), but root reoperations had a higher hospital mortality than primary root procedures (p=.07). Univariate predictors of hospital death following reoperation were EF ≤ 30% (p≤.001), CAD (p=.03), non-elective procedure (p=.04), and cannulation site other than axillary artery (p=.07), and, in arch redos, concomitant CABG (p≤.01). Multivariate predictors for hospital death following reoperation were EF ≤ 30% (p≤.01) for root, and for arch reoperations, concomitant CABG (p≤.01), non-elective procedure (p≤.01) and presence of clot or atheroma (p≤.07). There was no significant difference in mortality risk after hospital discharge between redo and primary procedures. CONCLUSIONS: In this series, reoperations in the transverse arch carry the same risk as primary arch procedures. A higher operative mortality is expected for redo root operations. There is no difference in the longevity of hospital survivors undergoing primary versus redo operations in either the aortic root or arch. 
Back to 86th Annual Meeting Back to Program Outline |
We Model Excellence |
|
Copyright © American Association for Thoracic Surgery. All rights reserved.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.