Reoperation on the Aortic Root after Previous Cardiac Surgery: Predictors of Outcome

Abstract
Background: Reoperations on the aortic root and the ascending aorta are being performed with increasing frequency and remain a challenging problem. The aim of our work is to study the surgical strategy, results and predictors of outcome of aortic root surgery in patients with previous cardiac operations.
Aim of Study: Is to report our experience with patients undergoing re-operation on the proximal thoracic aorta after previous cardiac surgery, to highlight special surgical consid-erations needed in this particular entity and to identify pre-dictors of outcome.
Patients and Methods: Between 2008 and 2016, 35 patients had reoperation on the aortic root after previous Cardiac Surgery at Kasr Al-Aini Cardiac Surgery Unit, Cairo Univer-sity. Their age ranged from 9 to 58 years. 4 patients had bicuspid aortic valve and 5 patients had Marfan syndrome. The main indication for reoperation was ascending aortic aneurysm (45.7%), followed by aortic valve pathology (22.9%), infective endocarditis involving the aortic root (17.1%) and type A aortic dissection (14.3%). 13 patients had modified Bentall procedure, 9 had supra coronary conduit replacement of ascending aorta, 5 had aortic valve replacement, 4 patients had supra coronary conduit and aortic valve replacement, 2 patients had biological root replacement with homograft, one patient had David procedure, and one patient had Bentall with Elephant trunk procedure.
Results: The mean cardio-pulmonary bypass time was 163±10min and the mean cross clamp time 134±9min. Re-exploration for bleeding was needed in 2 patients. There was 5 in hospital mortality (14.3%): 3 due to multi organ failure due to sepsis of active endocarditis, 1 due to myocardial failure and 1 due to major uncontrollable bleeding.
Conclusion: Short-term survival following aortic root reoperation is good for patients with degenerative aneurysms and healed infection, acceptable in cases of dissection, poor in patients with active endocarditis.
Long bypass time, active infection, time interval between surgeries less than one year were independent predictors of mortality.