Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany.
Eur J Cardiothorac Surg. 2019 Feb 1;55(2):232-237. doi: 10.1093/ejcts/ezy237.
There are limited data on aortic root replacement (ARR) in patients with previous cardiac surgery. We analysed short-term and long-term results for patients with ARR after previous cardiac surgery.
From September 1995 to April 2015, 130 patients underwent reoperative ARR. Fifty patients had undergone ARR previously (Group I), and 80 had been treated by isolated aortic valve repair or replacement (Group II). The primary indications for surgery were active endocarditis in 65 patients (50%), aneurysmatic root dilatation in another 37 (28.5%) and valve failure in 27 (20.8%).
Overall hospital mortality was 10% (n = 13). Survival at 10 and 15 years was 59.4% and 40.6%, respectively. Survival at 10 and 15 years was 71.5% and 62.5% in Group I and 56.2% and 35.4% in Group II, respectively (P = 0.14). Survival was significantly worse in patients operated for active endocarditis (23.7% vs 56.4% at 15 years; P < 0.001). Inferior 15-year survival was also observed for patients requiring concomitant surgery for cardiac comorbidities (10.5% vs 48.7%; P = 0.003) and in the elderly (≥60 years; 26.8% vs 59.5%; P < 0.001). Ten-year survival was best in patients after valve-preserving root replacement (100%). Multivariable analysis revealed age, active endocarditis and concomitant surgery for cardiac comorbidities as risk factors for death.
ARR after previous cardiac surgery can be performed with reasonable short-term and long-term survival. It is inferior in patients with active endocarditis or cardiac comorbidities and in the elderly. In these scenarios, less invasive procedures may be considered where applicable.
既往心脏手术后行主动脉根部置换术（ARR）的数据有限。我们分析了既往心脏手术后行 ARR 的患者的短期和长期结果。
1995 年 9 月至 2015 年 4 月，130 例患者接受了再次 ARR。50 例（组 I）患者既往行 ARR，80 例（组 II）患者单纯行主动脉瓣修复或置换。手术的主要适应证为 65 例（50%）活动性心内膜炎、37 例（28.5%）动脉瘤性根部扩张和 27 例（20.8%）瓣叶功能障碍。
总体院内死亡率为 10%（n=13）。10 年和 15 年生存率分别为 59.4%和 40.6%。组 I 的 10 年和 15 年生存率分别为 71.5%和 62.5%，组 II 分别为 56.2%和 35.4%（P=0.14）。因活动性心内膜炎而手术的患者生存率显著较低（15 年时为 23.7% vs 56.4%；P<0.001）。需要同时治疗心脏合并症的患者（10.5% vs 48.7%；P=0.003）和老年患者（≥60 岁；26.8% vs 59.5%；P<0.001）的 15 年生存率也较差。行保留瓣叶根部置换术的患者 10 年生存率最佳（100%）。多变量分析显示，年龄、活动性心内膜炎和同时治疗心脏合并症是死亡的危险因素。
既往心脏手术后行 ARR 可获得较好的短期和长期生存率。在活动性心内膜炎或心脏合并症患者和老年患者中生存率较低。在这些情况下，如有可能，可考虑采用创伤较小的方法。
