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 （10 cases）, 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 7 patients 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.