Redo aortic root surgery for failure of an aortic homograft is a major technical challenge

Joudinaud, Thomas M.; Baron, Franck; Raffoul, Richard; Pagis, Bruno; Vergnat, Mathieu; Parisot, Caroline; Hvass, Ulrik; Nataf, Patrick R.
June 2008
European Journal of Cardio-Thoracic Surgery;Jun2008, Vol. 33 Issue 6, p989
Academic Journal
Abstract: Objective: Aortic homografts offer many advantages over prosthetic valves. However, homograft dysfunction due to degeneration or infection may lead to reoperation. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge. To assess reoperation events a retrospective review was conducted. Materials and methods: From January 2000 to October 2006, 20 consecutive patients (38.8±14.9 years old) underwent repeat surgery for aortic homograft failure. Results: Reoperation was performed 7.2±3.5 years after implantation of the aortic homograft as a root. Indication was homograft degeneration (n =18 [90%]) and endocarditis (n =2 [10%]). In patients with major homograft wall calcifications or endocarditis, nine aortic root reconstructions were performed (Bentall procedure n =7; homograft implantation n =2). Each homograft was dissected with electrical cauterization and removed ‘en-bloc’ sparing the coronary buttons. In case of flexible homograft wall, stented prostheses (mechanical n =10, bioprosthesis n =1) were implanted along the homograft annulus. Additional procedures consisted of mitral valve replacements (n =8), tricuspid repairs (n =4), Konno procedure (n =1) and coronary bypass (n =5). Perioperative complications occurred in seven (35%) patients: sternal re-entry accident (n =2); reoperations for mediastinitis (n =1) or bleeding (n =2); renal insufficiency (n =1); total heart block (n =1). No association was found between operative procedures and postoperative complications (Fisher''s exact test). Two patients (10%) died from multiorgan failure in the early postoperative period. In total, 94.4% of the survivors remained free from reoperation at 74 months. Conclusion: Reoperation on patients with an aortic homograft as a root presents a relatively high perioperative morbidity. The surgical strategy depends on the degree of homograft wall calcification.


Related Articles

  • Bileaflet mechanical prostheses for aortic valve replacement in patients younger than 65 years and 65 years of age or older: Major thromboembolic and hemorrhagic complications. Jamieson, W.R. Eric; Miyagishima, Robert T.; Grunkemeier, Gary L.; Germann, Eva; Henderson, Charmaine; Lichtenstein, Samuel V.; Ling, Hilton; Munro, A. Ian // Canadian Journal of Surgery;Feb99, Vol. 42 Issue 1, p27 

    Examines the major thromboembolic and hemorrhagic complications and predictive risk factors associated with aortic valve replacement (AVR) using bileaflet mechanical prostheses. Profile of the patients; Incidence of coronary artery disease; Major thromboembolic and hemorrhagic complications...

  • TAVI boon for high-risk patients. Majumder, Bikash // Telegraph (Calcutta, India);1/20/2016, p10 

    The article discusses the advantage of transcatheter aortic valve implantation (TAVI) as an alternative to conventional open surgical valve replacement for high-risk patients.

  • Prospective evaluation of aortic stenosis in end-stage kidney disease: a more fulminant process? Zentner, Dominica; Hunt, David; Chan, William; Barzi, Federica; Grigg, Leeanne; Perkovic, Vlado // Nephrology Dialysis Transplantation;May2011, Vol. 26 Issue 5, p1651 

    Background. We have previously demonstrated an increased rate of progression of aortic stenosis (AS) in patients with end-stage kidney disease (CKD 5D) compared to controls. We sought to follow prospectively a CKD 5D cohort with AS and determine major event-free survival. Follow-up was...

  • Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study. Rahe-Meyer, N.; Pichlmaier, M.; Haverich, A.; Solomon, C.; Winterhalter, M.; Piepenbrock, S.; Tanaka, K. A. // BJA: The British Journal of Anaesthesia;Jun2009, Vol. 102 Issue 6, p785 

    : Background Bleeding diathesis after aortic valve operation and ascending aorta replacement (AV–AA) is managed with fresh-frozen plasma (FFP) and platelet concentrates. The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry...

  • Comparison of Risk Scores for Prediction of Complications following Aortic Valve Replacement. Wang, Tom Kai Ming; Choi, David Hyun-Min; Haydock, David; Gamble, Greg; Stewart, Ralph; Ruygrok, Peter // Heart, Lung & Circulation;Jun2015, Vol. 24 Issue 6, p595 

    Background Risk models play an important role in stratification of patients for cardiac surgery, but their prognostic utilities for post-operative complications are rarely studied. We compared the EuroSCORE, EuroSCORE II, Society of Thoracic Surgeon's (STS) Score and an Australasian model...

  • Free Intra-Abdominal Hemorrhage after Open-Heart Surgery. Iriz, Erkan; Ereren, Emrah; Yuksel, Osman; Kalaycioglu, Sedat // Texas Heart Institute Journal;2006, Vol. 33 Issue 4, p523 

    Gastrointestinal complications after open-heart surgery are rare. Many preoperative, intraoperative, and postoperative factors may predispose patients to these complications or cause them. Our patient was a 64-year-old woman who underwent aortic valve replacement due to aortic stenosis. Free...

  • Closure of a Paravalvular Aortic Leak with the Use of 2 AMPLATZER Devices and Real-Time 2- and 3-Dimensional Transesophageal Echocardiography. Hoffmayer, Kurt S.; Zellner, Christian; Kwan, Damon M.; Konety, Suma; Foster, Elyse; Moore, Phillip; Yeghiazarians, Yerem // Texas Heart Institute Journal;2011, Vol. 38 Issue 1, p81 

    Paravalvular leaks are well-recognized sequelae of mechanical aortic valve implantation. Clinical manifestations include hemolysis, arrhythmias, and congestive heart failure. Frequently, patients who receive mechanical aortic valves are poor candidates for repeat valve surgery, and the...

  • Surgical Treatment of the Cardiac Manifestations of Relapsing Polychondritis: Overview of 33 Patients Identified Through Literature Review and the Mayo Clinic Records. Dib, Chadi; Moustafa, Sherif E.; Mookadam, Martina; Zehr, Kenton J.; Michet Jr, Clement J.; Mookadam, Farouk // Mayo Clinic Proceedings;Jun2006, Vol. 81 Issue 6, p772 

    OBJECTIVES: To analyze the cardiac findings that necessitate surgery in patients with relapsing polychondritis (RP) and to compare our results to cases in the literature. MATERIAL AND METHODS: A systematic overview of the literature was completed with the addition of cases of RP from the Mayo...

  • Determinants of pericardial drainage for cardiac tamponade following cardiac surgery. Pompilio, Giulio; Filippini, Sara; Agrifoglio, Marco; Merati, Elisa; Lauri, Gianfranco; Salis, Stefano; Alamanni, Francesco; Parolari, Alessandro // European Journal of Cardio-Thoracic Surgery;May2011, Vol. 39 Issue 5, pe107 

    Abstract: Objective: We aimed to identify independent risk factors predisposing toward postoperative surgical or percutaneous pericardial drainage following cardiac surgery, and to assess late survival. Methods: A retrospective review of preoperative, intra-operative and postoperative variables...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics