[Reoperative aortic root replacement].

Our experiences of secondary aortic root replacement after proximal aortic operation and their technical details are presented. Between November 1999 and February 2013, 50 patients underwent reoperative aortic root replacement(34 male, mean age 59.6±13.1 years). The mode of previous operation was ascending and arch replacement in 21, aortic valve replacement (AVR) in 19, and aortic root replacement in 10. Indications for reoperation included root dilation( n=13), aortic root abscess( n=13), residual proximal dissection (n=12), formation of pseudoaneurysm (n=5)and graft infection (n=3), and non-structural valve dysfunction (n=4). Mean interval from 1st operation was 84.3±85.2 months (range, 0.8 month~11.8 years). At reoperation, 29(58.0%)patients had Bentall operation, 11(22.0%)had valve sparing root replacement, 5(10.0%)had prosthetic valve preserved root replacement and 5(10.0%)had partial replacement of Valsalva sinus without reimplantation of coronaries. In-hospital mortality was 8.0%(4 of 50). The cause of mortality was sepsis in 2, low-output syndrome in 1 and hemorrhagic stroke in 1. During follow-up, 2 patients had a 3rd-time root replacement for pseudoaneurysm formation and infective endocarditis. Other 2 patients needed coronary artery bypass grafting(CABG) and AVR for structural valve deterioration. Freedom from 3rd-time aortic root related operation was 90.2±4.7% at 10 years. Actuarial survival after reoperation was 84.6±6.3% at 10 years. In conclusion, reoperative aortic root replacement can be performed with acceptable outcomes even in patients with complicated aortic pathologies.