• Megan M Chung, Kavya Rajesh, Chris He, Yanling Zhao, Yu Hohri, Valeria Jimenez, Gift Owolabi, Elizabeth Norton, Paul Kurlansky, Bradley Leshnower, Edward P Chen, and Hiroo Takayama.
• Divison of Cardiovascular and Thoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2025 Jan 10.

ObjectivesAlthough valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in reoperative sternotomy settings remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR.MethodsAll consecutive VSRR procedures at 2 centers from 2005 to 2020 were included. Reoperative VSRR was defined as prior sternotomy for any reason. Time-dependent outcomes were compared between groups after balancing of covariates with inverse probability of treatment weighting. Multivariable Cox regression and the Fine-Gray subdistribution hazard model were used to identify factors associated with 10-year survival and aortic valve reintervention, respectively.ResultsOf 778 VSRR procedures, 69 (8.9%) were reoperative sternotomies. Compared with primary, patients undergoing reoperative VSRR were younger (age 43 years [range, 34-54 years] vs age 51 years [range, 39-61 years]; P < .001) and had less aortic insufficiency (33.3% vs 48.5%; P = .02). Cardiopulmonary bypass times were longer in reoperative VSRR with similar rates of circulatory arrest. Reoperative VSRR had a higher incidence of postoperative acute kidney injury (10.1% vs 3.2%; P = .01) and prolonged ventilation (24.6% vs 9.9%; P < .001); operative mortality was higher in reoperative VSRR (2.9% [2 out of 69] vs 1.4% [10 out of 709]) although not significantly (P = .66). Ten-year survival was 82.0% (range, 70.0%-96.0%) and aortic valve reintervention rate was 11.8% (range, 2.3%-19.4%) after reoperative VSRR. After inverse probability of treatment weighting adjustment, survival and aortic valve reintervention rates were not different. Reoperative sternotomy was not associated with long-term mortality (P = .13) or aortic valve reintervention (P = .77) on multivariable analysis.ConclusionsAlthough complex, reoperative sternotomy VSRR can be performed with low operative mortality in carefully selected patients. Ten-year survival and aortic valve reintervention rates were acceptable and comparable to primary VSRR.Copyright © 2025 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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