A multicenter analysis of aortic root replacement: Non-native chest increases risk of postoperative mortality

Objective: Re-do root replacement poses a significant technical challenge, increasing the potential risk of morbidity and mortality. This multi-institution study compared the outcomes of aortic root replacement stratified by chest surgery and aortic root history.

Methods: A retrospective review by the Western Aortic Collaborative was performed of 3 different aortic centers for patients who underwent nonemergency root replacement from 2017 to 2023 with exclusion of patients who underwent more than hemiarch replacement or presented with acute or hyperacute aortic dissection. Patients were stratified into 3 cohorts: native chest, prior sternotomy with no previous root replacement, and true re-do root replacement. Univariate and multivariable logistic regression was performed for the primary end point of in-hospital or 30-day mortality and secondary end points.

Results: A total of 568 patients underwent elective or urgent root replacement, with 338 (59.5%) in the native chest cohort, 165 (29.1%) in the no previous root replacement cohort, and 65 (11.4%) in the true re-do root replacement cohort. The no previous root replacement and true re-do root replacement cohorts were more likely to undergo nonvalve-sparing root replacement (P < .001) and concomitant coronary artery bypass grafting (P = .002) and less likely to undergo hemiarch repair (P < .001). Multivariable analysis showed additional risk associated with prior sternotomy, rather than having a previous root performed.

Conclusions: Patients undergoing root replacement in a non-native chest have a significant risk of morbidity and mortality. However, prior root and true re-do root replacement do not appear to add additional risk, with primary risk contributed by operating in a prior surgical field.