Aortic root surgery in the United States: A report from the Society of Thoracic Surgeons database

Abstract

The purpose of the present study was to evaluate the early clinical outcomes of aortic root surgery in the United States. The Society of Thoracic Surgeons database was queried to identify all patients who had undergone aortic root replacement from 2004 to early 2010 (n=13,743). The median age was 58 years (range, 18-96); 3961were women (29%) and 12,059 were white (88%). The different procedures included placement of a mechanical valve conduit (n=4718, 34%), stented pericardial (n=879, 6.4%) or porcine (n=478, 3.5%) bioprosthesis, stentless root (n=4309, 31%), homograft (n=498, 3.6%), and valve sparing root replacement (n=1918, 14%). The median number of aortic root surgeries per site was 2, and only 5% of sites performed >16 aortic root surgeries annually. An increased trend to use biostented (porcine or pericardial) valves during the study period (7% in 2004 vs 14% in 2009). The operative (raw) mortality was greater among the patients with aortic stenosis (6.2%) who had undergone aortic root replacement, independent of age. Mortality was greater in patients who had undergone concomitant valve or coronary artery bypass grafting or valve surgery (21%). The lowest operative mortality was observed in patients who had undergone aortic valve sparing procedures (1.9%). Most cardiac centers performed aortic root surgery in small volumes. The unadjusted operative mortality was greater for patients >80 years old and those with aortic stenosis, regardless of age. Valve sparing root surgery was associated with the lowest mortality. A trend was seen toward an increased use of stented tissue valves from 2004 to 2009.