Clinical analysis of redo aortic root replacement after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Jie , XUE Qing , TANG Yangfeng , SONG Zhigang , TANG Hao , LU Fanglin , HAN Lin ,  XU Zhiyun

Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, P.R.China;

Corresponding author：

XU Zhiyun, Email: zhiyunxu@hotmail.com

Keywords：

Aortic root replacement; cardiac reoperation; aortic diseases; surgery

DOI：

10.7507/1007-4848.202003100

Video：

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Objective To analyze the etiologies, operation techniques and outcomes of redo aortic root replacement after cardiac surgery.Methods Between December 2013 and December 2019, 30 patients who had at least one previous cardiac operation received aortic root replacement in our hospital, including 20 males and 10 females with an average age of 50.4±12.7 years. The mean time interval between this operation and the previous one was 8.0±8.5 years. The principal indication for surgery was aortic sinus dilatation and ascending aortic aneurysm in 14 patients (47%), acute aortic dissection in 5 patients (17%), pseudoaneurysm in 3 patients (10%), prosthetic valve endocarditis in 4 patients (13%), prosthetic leakage in 4 patients (13%). Bentall procedure was used in all 30 patients, with concomitant mitral valve plasticity or replacement in 5 patients, tricuspid valve plasticity in 6 patients, coronary artery bypass grafting in 3 patients, and total aortic arch replacement and elephant trunk procedure in 2 patients.Results The mean cardiopulmonary bypass time was 96-296 (161.3±43.0) min, and the mean aortic occlusion time was 48-117 (85.7±20.4) min. There were 5 in-hospital deaths with an overall in-hospital mortality of 17%. The causes of deaths were low cardiac output syndrome in 2 patients and septic shock in 3 patients. The follow-up time was 3-75 (33.5±21.1) months. Three patients died during the follow-up, 1 patient died of septic shock and 2 died of cerebral hemorrhage.Conclusion Redo aortic root replacement is difficult to deal with, and the risk is high. Preoperative evaluation is required, appropriate surgical approach, adequate myocardial protection, and a complete surgical plan are essential to ensure the success of the operation.

Citation： LU Jie, XUE Qing, TANG Yangfeng, SONG Zhigang, TANG Hao, LU Fanglin, HAN Lin, XU Zhiyun. Clinical analysis of redo aortic root replacement after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 99-103. doi: 10.7507/1007-4848.202003100 Copy

1.	Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2.	孙衍庆. 现代胸心外科学. 北京: 人民军医出版社, 2000.
3.	Fukunaga N, Koyama T, Konishi Y, et al. Clinical outcome of redo operation on aortic root. Gen Thorac Cardiovasc Surg, 2014, 62(4): 215-220.
4.	Jassar AS, Desai ND, Kobrin D, et al. Outcomes of aortic root replacement after previous aortic root replacement: The "true" redo root. Ann Thorac Surg, 2015, 99(5): 1601-1608.
5.	Raanani E, David TE, Dellgren G, et al. Redo aortic root replacement: Experience with 31 patients. Ann Thorac Surg, 2001, 71(5): 1460-1463.
6.	Urbanski PP, Lakew F, Dinstak W, et al. Bentall procedure after previous aortic valve or complete root replacement: Usefulness of self-assembled aortic valve conduit. J Thorac Cardiovasc Surg, 2018, 156(1): 89-95.
7.	Shrestha M, Khaladj N, Baraki H, et al. Aortic root reoperation: A technical challenge. J Heart Valve Dis, 2010, 19(2): 177-181.
8.	Dobell AR, Jain AK. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg, 1984, 37(4): 273-278.
9.	Di Bartolomeo R, Berretta P, Petridis FD, et al. Reoperative surgery on the thoracic aorta. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S78-S84.
10.	Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: Simple prediction based on size. Ann Thorac Surg, 2002, 73(1): 17-27.
11.	Matsuyama K, Usui A, Akita T, et al. Natural history of a dilated ascending aorta after aortic valve replacement. Circ J, 2005, 69(4): 392-396.
12.	Kawachi Y, Nakashima A, Kosuga T, et al. Comparative study of the natural history and operative outcome in patients 75 years and older with thoracic aortic aneurysm. Circ J, 2003, 67(7): 592-596.
13.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv, 2010, 76(2): E43-E86.
14.	von Kodolitsch Y, Loose R, Ostermeyer J, et al. Proximal aortic dissection late after aortic valve surgery: 119 cases of a distinct clinical entity. Thorac Cardiovasc Surg, 2000, 48(6): 342-346.
15.	Manenti A, Zizzo M, Fedeli C, et al. Coronary artery pseudoaneurysm after bentall procedure. Ann Thorac Surg, 2016, 102(4): 1409.
16.	Chello C, Lusini M, Nenna A, et al. Deep sternal wound infection (DSWI) and mediastinitis after cardiac surgery: current approaches and future trends in prevention and management. Surg Technol Int, 2020, 36: 212-216.
17.	Fleck T, Fleck M. Negative pressure wound therapy for the treatment of sternal wound infections after cardiac surgery. Int Wound J, 2014, 11(3): 240-245.
18.	Arsalan-Werner A, Dick L, Arsalan M, et al. Impact of microbial findings on plastic reconstructive surgery outcomes in patients with deep sternal wound infection after cardiac surgery. J Plast Surg Hand Surg, 2020, 54(3): 182-186.
19.	Luciani N, De Geest R, Anselmi A, et al. Results of reoperation on the aortic root and the ascending aorta. Ann Thorac Surg, 2011, 92(3): 898-903.
20.	Bachet J, Goudot B, Dreyfus G, et al. Current practice in Marfan's syndrome and annulo-aortic ectasia: Aortic root replacement with a composite graft over a twenty-year Period. J Card Surg, 1997, 12(2 Suppl): 157-166.
21.	Sioris T, David TE, Ivanov J, et al. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg, 2004, 128(2): 260-265.
22.	David TE, Ivanov J, Armstrong S, et al. Late results of heart valve replacement with the HancockⅡ bioprosthesis. J Thorac Cardiovasc Surg, 2001, 121(2): 268-277.

1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2. 孙衍庆. 现代胸心外科学. 北京: 人民军医出版社, 2000.
3. Fukunaga N, Koyama T, Konishi Y, et al. Clinical outcome of redo operation on aortic root. Gen Thorac Cardiovasc Surg, 2014, 62(4): 215-220.
4. Jassar AS, Desai ND, Kobrin D, et al. Outcomes of aortic root replacement after previous aortic root replacement: The "true" redo root. Ann Thorac Surg, 2015, 99(5): 1601-1608.
5. Raanani E, David TE, Dellgren G, et al. Redo aortic root replacement: Experience with 31 patients. Ann Thorac Surg, 2001, 71(5): 1460-1463.
6. Urbanski PP, Lakew F, Dinstak W, et al. Bentall procedure after previous aortic valve or complete root replacement: Usefulness of self-assembled aortic valve conduit. J Thorac Cardiovasc Surg, 2018, 156(1): 89-95.
7. Shrestha M, Khaladj N, Baraki H, et al. Aortic root reoperation: A technical challenge. J Heart Valve Dis, 2010, 19(2): 177-181.
8. Dobell AR, Jain AK. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg, 1984, 37(4): 273-278.
9. Di Bartolomeo R, Berretta P, Petridis FD, et al. Reoperative surgery on the thoracic aorta. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S78-S84.
10. Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: Simple prediction based on size. Ann Thorac Surg, 2002, 73(1): 17-27.
11. Matsuyama K, Usui A, Akita T, et al. Natural history of a dilated ascending aorta after aortic valve replacement. Circ J, 2005, 69(4): 392-396.
12. Kawachi Y, Nakashima A, Kosuga T, et al. Comparative study of the natural history and operative outcome in patients 75 years and older with thoracic aortic aneurysm. Circ J, 2003, 67(7): 592-596.
13. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv, 2010, 76(2): E43-E86.
14. von Kodolitsch Y, Loose R, Ostermeyer J, et al. Proximal aortic dissection late after aortic valve surgery: 119 cases of a distinct clinical entity. Thorac Cardiovasc Surg, 2000, 48(6): 342-346.
15. Manenti A, Zizzo M, Fedeli C, et al. Coronary artery pseudoaneurysm after bentall procedure. Ann Thorac Surg, 2016, 102(4): 1409.
16. Chello C, Lusini M, Nenna A, et al. Deep sternal wound infection (DSWI) and mediastinitis after cardiac surgery: current approaches and future trends in prevention and management. Surg Technol Int, 2020, 36: 212-216.
17. Fleck T, Fleck M. Negative pressure wound therapy for the treatment of sternal wound infections after cardiac surgery. Int Wound J, 2014, 11(3): 240-245.
18. Arsalan-Werner A, Dick L, Arsalan M, et al. Impact of microbial findings on plastic reconstructive surgery outcomes in patients with deep sternal wound infection after cardiac surgery. J Plast Surg Hand Surg, 2020, 54(3): 182-186.
19. Luciani N, De Geest R, Anselmi A, et al. Results of reoperation on the aortic root and the ascending aorta. Ann Thorac Surg, 2011, 92(3): 898-903.
20. Bachet J, Goudot B, Dreyfus G, et al. Current practice in Marfan's syndrome and annulo-aortic ectasia: Aortic root replacement with a composite graft over a twenty-year Period. J Card Surg, 1997, 12(2 Suppl): 157-166.
21. Sioris T, David TE, Ivanov J, et al. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg, 2004, 128(2): 260-265.
22. David TE, Ivanov J, Armstrong S, et al. Late results of heart valve replacement with the HancockⅡ bioprosthesis. J Thorac Cardiovasc Surg, 2001, 121(2): 268-277.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of redo aortic root replacement after cardiac surgery

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