Document Detail

Aortic root reoperation: a technical challenge.
MedLine Citation:
PMID:  20369500     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: It is well known that aortic root re-replacement presents a formidable technical challenge. Thus, the study aim was to describe the authors' experience with this high-risk cohort. METHODS: Between August 1996 and January 2009, a total of 26 patients (mean age 51 years; range: 16-72 years) underwent aortic root re-replacement surgery at the authors' institution. Previous aortic root operations included mechanical valved conduit (n = 9), tissue valved conduit (n = 5), Ross procedure (n = 4), homograft (n = 4), David procedure (n = 2) and Yacoub procedure (n = 2). The indications for surgery included endocarditis (n = 16), Ross procedure failure (n = 4), valve degeneration (n = 3), anastomotic aneurysm (n = 2), and severe valve insufficiency (n = 1). RESULTS: The reoperations performed were classified as follows: aortic homograft (n = 11), mechanical conduit (n = 9), tissue valved conduit (n = 4) and David procedure (n = 2). The mean cardiopulmonary bypass time was 219 min (range: 101-398 min), and the mean cross-clamp time 142 min (range: 89-253 min). The mean ICU stay was 8 days (range: 1-45 days), and the mean hospital stay 20 days (range: 3-64 days). Four rethoracotomies were performed for postoperative bleeding or tamponade (14%). Two patients (8%) died within 30 days of surgery, and three (12%) required pacemaker implantation due to atrioventricular block (grade III). CONCLUSION: Aortic root reoperation, even in the setting of endocarditis, can be carried out with excellent results. The major goals of this concept include a clinical examination and preoperative diagnosis, in addition to computed tomography to identify possible pitfalls during re-sternotomy. Care must also be taken to provide adequate myocardial and organ protection, by utilizing blood cardioplegia and individual selective perfusion techniques.
Malakh Shrestha; Nawid Khaladj; Hassina Baraki; Ammar Al Ahmad; Nurbol Koigeldiyev; Maximilian Pichlmaier; Axel Haverich; Christian Hagl
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  19     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-04-07     Completed Date:  2010-05-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  177-81     Citation Subset:  IM    
Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hannover, Germany.
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MeSH Terms
Aorta, Thoracic / surgery
Aortic Valve / surgery*,  transplantation
Blood Vessel Prosthesis Implantation
Heart Valve Prosthesis Implantation* / mortality
Intensive Care Units
Length of Stay
Middle Aged
Postoperative Complications
Reoperation / mortality
Survival Rate
Young Adult

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