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

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. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved

Thoracic aortic surgery: An overview of 40 years clinical practice

Objective: The objective of our study was to report on the total experience in thoracic aortic surgery over a 40-year time period for a single institution. Methods: All 1075 patients who underwent surgery for thoracic aortic pathology from 1972 to 2011 (n = 1159) were included. Patient, procedural, and follow-up information was obtained from hospital records and the civil registry. Patients were grouped into 4 categories: acute type A dissection (n = 261), other ascending aortic/arch surgery (n = 626), descending aortic surgery (n = 175), and thoracoabdominal surgery (n = 97). Risk factors for early and late mortality and the incidence of reoperations were analyzed. Results: The annual number of operations increased significantly over time. In all 4 patient groups, early mortality (in hospital or within 30 days of operation) decreased significantly over time to 15.3% in group 1, 1.9% in group 2, 0% in group 3, and 10.5% in group 4 during the contemporary time period 2007 to 2011. Overall actuarial survival was 54.3% (95% confidence interval, 50.7-57.9) after 10 years and 27.8% (95% confidence interval, 26.4-38.3) after 20 years. Late survival improved over time, but was reduced compared with the general population and was related predominantly to preexisting risk factors. In 80 patients, 111 reoperations were necessary, most frequently in group 1 patients and in patients with connective tissue disease. Conclusions: Thora cic aortic operations were performed increasingly during a 40-year time period. Early mortality decreased and late survival increased significantly in all patient groups. A significant proportion of patients required multiple operations