Reoperation Following Aortic Root Replacement and its Impact on Long-term Survival

Objective Reoperation after aortic root replacement (ARR) is associated with increased operative risk and complexity. This study evaluated clinical outcomes and reoperation rates in patients undergoing ARR. Methods From 2004-2021, 2700 adult patients underwent an ARR in a two-institution database. Among 2542 surviving patients, 705 patients had a history of prior cardiac surgery as well as 11 patients underwent TAVR after index ARR were excluded. Among the finalized cohort of 1826 patients, 88(4.8%) underwent a reoperation(REDO) on the aortic valve or proximal aorta (root/ascending) a mean of 3.1 years following index ARR while 1738(95%) did not undergo reoperation(No-REDO). A subgroup analysis was performed among those undergoing reoperation by indication including valve dysfunction(48%), endocarditis/graft infection(33%), and aortic aneurysm/dissection/rupture(12%). Reoperative indication was unknown in six patients(7%). Results The REDO group was younger at time of index ARR (52 vs 58 years, p<0.0001) and had more bicuspid aortic valves (56% vs 37%, p=0.0003). Most patients underwent modified Bentall ARR (61%) while 38% underwent a valve-sparing root replacement. Index root operations were similar between groups. At time of reoperation, 53% underwent aortic valve replacement and 35% underwent redo root replacement. Long-term survival was similar between REDO and No-REDO groups (80% vs 85%, p=0.26) and reoperation was not a risk factor for late mortality (HR=1.31, p=0.26); however, redo-ARR was a risk factor for late mortality (HR=2.41, p=0.02). Conclusion The incidence of aortic valve and/or proximal aorta reoperation following index ARR is relatively low at 4.8%, however, root reoperation is a risk factor for late mortality.