TITLE

Re-operations for aortic allograft root failure: experience from a 21-year single-center prospective follow-up study

AUTHOR(S)
Bekkers, Jos A.; Klieverik, Loes M.A.; Raap, Goris Bol; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C.
PUB. DATE
July 2011
SOURCE
European Journal of Cardio-Thoracic Surgery;Jul2011, Vol. 40 Issue 1, p35
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Objective: The study aims to report results of re-operations after aortic allograft root implantation. Methods: All consecutive patients in our prospective allograft database, who underwent aortic allograft root implantation, were selected for analysis, and additional information for patients who subsequently underwent re-operation was obtained from hospital records. Results: From 1989 to 2009, 262 aortic allograft root implantations were performed. Thirty-day mortality was 5.7%. During follow-up, 69 patients died. The actuarial survival was 77.0% (95% confidence interval (CI) 71–83%) after 10 years, and 65.1% (95% CI 57–74%) after 14 years. A total of 52 patients required re-operation. The actuarial freedom from allograft re-operation was 82.9% (Standard Error (SE) 2.9%) after 10 years and 55.7% (SE 5.7%) after 14 years. The actuarial median time to re-operation was 14.8 years. The indications for re-operation were structural valve dysfunction in 46 patients, endocarditis in two patients and non-structural valve dysfunction in four patients. The re-operations included 23 aortic valve replacements (mechanical prostheses 20 and bioprostheses 3), 27 aortic root replacements (mechanical conduits 21, aortic allografts five, and biological conduit one), one trans-apical valve implantation and one primary closure of a false aneurysm. The additional procedures were mitral valve repair (N =5), mitral valve replacement (N =1), ascending aortic replacement (N =5), and coronary artery bypass grafting (CABG) (N =4; in two patients unforeseen). Thirty-day mortality after re-operation occurred in two patients (3.9%). Five patients died during follow-up. The survival after re-operation was 87.1% (SE 5.5%) after 1 year and 79.3% (SE 7.4%) after 9 years. Conclusions: Re-operations after aortic allograft root implantation will be required in a substantial and growing number of patients. These re-operations, although technically demanding, can be performed with satisfying results.
ACCESSION #
61175232

 

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