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J Thorac Cardiovasc Surg 2008;136:860-867
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Reoperative aortic root and transverse arch procedures: A comparison with contemporaneous primary operations

^a Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY
^b Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY

^_* Address for reprints: Christian D. Etz, MD, Mount Sinai School of Medicine, Department of Cardiothoracic Surgery, One Gustave L. Levy Place, PO Box: 1028, New York, NY 10029. (Email: christian.etz{at}mountsinai.org).

Objectives: Long-term survival and risk factors affecting outcome after reoperative root/ascending aorta and transverse arch procedures have not been clearly described.

Methods: Two hundred patients (138 male patients; age, 60 ± 15 years) underwent reoperative root/ascending aorta (n = 100) or transverse arch (n = 100) procedures at our institution from January 1998 to December 2004 and were compared with 480 consecutive contemporaneous patients with primary procedures (323 male patients; age, 62 ± 16 years; 335 proximal aorta and 145 transverse arch procedures).

Results: Reoperative proximal aorta procedures had a higher hospital mortality (7%) than primary root/ascending aorta procedures (3%), but there was a less dramatic difference in operative mortality after primary and reoperative arch procedures (9% vs 10%). Separate multivariable analyses of root/ascending aorta procedures and arch procedures revealed chronic obstructive pulmonary disease and age to be significant risk factors for death after either procedure. In addition, an ejection fraction of less than 30% posed a significant risk for proximal aortic surgery, and diabetes and nonelective operations predicted poorer outcome after arch operations. For survivors of root/ascending aorta operations, there was no significant difference in long-term outcome between reoperations and primary procedures, with both restoring longevity to expected levels for an age- and sex-matched normal population. Patients undergoing arch operations, however, continued to have a poorer long-term outlook than their normal peers.

Conclusions: In this series, reoperations in the transverse arch carry the same risk as primary arch procedures, but a higher operative mortality is seen with reoperative than with primary root/ascending aorta procedures. The long-term outlook is better for patients undergoing root/ascending operations than for patients undergoing aortic arch operations, with no difference in the longevity of patients undergoing primary procedures versus reoperations.