Redo Aortic Root Replacement After Prior Modified Inclusion Versus Total Aortic Root Replacement

Background: There is currently little data in the literature evaluating the long-term outcomes of reoperative aortic root replacement after previous aortic root replacement, and there are no studies comparing how these outcomes differ based on the approach of the initial aortic root replacement. Our objective was to determine the outcomes of reoperative aortic root replacement following prior aortic root replacement with either the total root or inclusion root techniques.

Methods: This study was a retrospective cohort analysis of 260 patients who underwent redo aortic root replacement from September 1994 to July 2024. Previous root replacements were done with the total root technique in 90 patients and inclusion root technique in 170 patients. The primary outcomes of the study were perioperative complications, operative mortality, and late survival.

Results: The median age of the entire cohort was 57 years, and 79% were males. The prior total root group was younger, had more Marfan syndrome, and more concomitant ascending/arch replacement. Perioperatively, the groups had similar recovery times and complication rates, though there was more postoperative sepsis in the prior total root group (5.6% vs. 0.6%), Operative mortality was 4.2% in the whole cohort; 5.6% in the total root group versus 3.5% in the inclusion root group, p = 0.44. Survival at 5 and 10 years was 84% and 70% in the whole cohort, respectively. The 5-year survival was similar between the groups at 81% in the total root group and 85% in the inclusion root group, p = 0.82. Cox proportional hazards regression showed infection as a primary indication and was a significant risk factor for late mortality (hazard ratio 2.55 [95% CI: 1.45, 4.50], p = 0.001), as was diabetes (HR: 2.00 [95% CI: 1.04, 3.82], p = 0.037), but previous total root versus inclusion root procedure was not (hazard ratio 1.10 [95% CI: 0.58, 2.09], p = 0.77).

Conclusions: Reoperative aortic root replacement following prior root replacement can be performed with good short- and long-term outcomes after either total root or inclusion root replacement.