Reoperation on aortic disease in patients with previous aortic valve surgery

Background Aortic valve replacement(AVR)is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients(38 males and 9 females)with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years((6.0±3.8)years).The secondary aortic surgery included aortic root replacement(14 cases),ascending aorta replacement(10cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation(21 cases),and total thoracoabdominal aorta replacement(2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection(25 cases,53%),ascending aortic aneurysm(12 cases,26%)or aortic root aneurysm(10 cases,21%).Diameter in ascending aorta increased(5.2±7.1)mm per year and aortic sinus(3.3±3.1)mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome(P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation;neurological complications occurred in 14 patients including 7patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was(97.25±17.63)months,95%confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly follow-up patients with previous aortic operation especially patients with Marfan syndrome and rheumatic heart disease.