Adverse Technical Events During Aortic Root Replacement

BACKGROUND Although adverse technical events during aortic root replacement (ARR) are not uncommon and are extremely challenging, there is little literature to help surgeons prepare for such situations. We describe our experience of outstanding technical events during ARR. METHODS This is a retrospective study of 830 consecutive ARR at a single center from 2012-2022. Technical events were defined as intraoperative events that led to an unplanned cardiac procedure, need for mechanical circulatory support, or additional aortic cross-clamping. Logistic regression identified factors associated with operative mortality and technical events. RESULTS Technical events occurred in 90 (10.8%) patients, and were attributed to bleeding (n=26), nonischemic ventricular dysfunction (n=23), residual valve disease (n=20), myocardial ischemia (n=19), and iatrogenic dissection (n=2). Prior sternotomy (OR 2.38 [1.36-4.19], p=0.002) and complex aortic valve disease (OR 3.09 [1.09-8.75], p=0.03) were associated with technical events. Patients with technical events had higher rates of operative mortality (6.7% vs 2.3%, p=0.03) and all major postoperative complications. Surgical indications of dissection (OR 13.57 [4.95-37.23], p<0.001) and complex aortic valve disease (OR 14.09 [3.67-54.02], p<0.001) but not adverse technical events (OR 2.42 [0.81-7.26], p=0.11) were associated with operative mortality. CONCLUSIONS Adverse technical events occur in 10.8% of ARR and were associated with reoperative sternotomies. Technical events are associated with increased postoperative complications.