In-hospital outcomes predictors and trends of redo sternotomy aortic root replacements: insights from a UK registry analysis

• DOI: 10.3389/fcvm.2023.1295968
• Publication Date: 2024-01-08T06:27:02Z
• Authors: Daniel P. Fudulu; Tim Dong; Rahul Kota; Shubhra Sinha; Jeremy Chan; Cha Rajakaruna; Arnaldo Dimagli; Gianni D. Angelini; Eltayeb Mohamed A...
• Keywords: Root Cause Analysis

Background Redo sternotomy aortic root surgery is technically demanding, and the evidence on outcomes mostly from retrospective, small sample, single-centre studies. We report trend, early clinical results outcome predictors of redo replacement over 20 years in United Kingdom. Methods retrospectively analysed collected data UK National Adult Cardiac Surgery Audit (NACSA) all replacements performed between 30th January 1998 19th March 2019. trends volume operations, characteristics hospital survivors vs. non-survivors, in-hospital outcomes. Results During study period, 1,107 were (median age 59, 26% patients females). Eighty-four per cent cases ( N = 931) underwent a composite replacement, 11% 119) had homograft valve-sparing was 5.1% 57) cases. There steady increase beyond 2006, an annual 22 procedures 2006 to 106 2017. Hospital mortality 17% n 192), postoperative stroke or TIA occurred 5.2% 58), dialysis required 109) patients. Return theatre for bleeding/tamponade 9% 102) median stay 9 days. Age >59 (OR: 2.99, CI: 1.92–4.65, P < 0.001), recent myocardial infarction 6.42, 2.24–18.41, 0.001) associated with increased mortality. Emergency 3.95, 2.27–6.86, endocarditis 2.05, 1.26–3.33, salvage coronary artery bypass grafting 2.20, 1.37–3.54, arch 2.47, 1.30–3.61, 0.018) cross-clamp longer than 169 min 2.17, 1.00–1.01, 0.003) risk found no effect centre surgeon > 0.05). Conclusions still carries significant morbidity sporadically across surgeons centres UK.