Aortic root replacement in adult patients with repaired congenital conotruncal defects-procedures, hospital survival, risk factors: A European Congenital Heart Surgeons Association database study.

Abstract

The study objectives were to characterize hospital survival and risk factors after aortic root replacement performed in adult patients by congenital units and to compare risk profiles of repaired conotruncal defects with other underlying diagnoses. After aortic root replacement in a congenital cardiac unit, adult patients were identified in the European Congenital Heart Surgeons Association database. Underlying pathology, prior surgeries, and types of index aortic root surgery were characterized. Primary end points were hospital and 30-day survival. Secondary end points included circulatory arrest, length of intensive care unit and hospital stays, and discharge to chronic care facility. Multiple logistic regression analyses were performed to test for independent risk factors. A total of 2544 patients were identified after full aortic root replacement performed in 101 different hospitals (1999-2024). A total of 249 patients (10%) with primary conotruncal defects included double-outlet right ventricle (n = 14, 6%), pulmonary atresia with ventricular septal defect (n = 42, 17%), transposition of the great arteries (n = 71, 29%), tetralogy of Fallot (n = 88, 35%), and truncus arteriosus communis (n = 34, 14%). Mechanical Bentall was performed in 163 cases (65%), valve-sparing was performed in 43 cases (17%), biological Bentall was performed in 20 cases (8%), and homograft replacement was performed in 23 cases (9%). Conotruncal diagnosis was linked to longer cardiopulmonary bypass times (P < .001), longer aortic crossclamp times (P < .001), longer intensive care unit stay (P < .001), and longer hospital stay (P < .001). Multiple logistic regression revealed duration of cardiopulmonary bypass (P < .001) and conotruncal lesion (odds ratio, 2.1, P = .037) as independent risk factors for hospital mortality. Among adult patients with congenital heart defects undergoing aortic root replacement, those with conotruncal defects represent a distinct subgroup characterized by a high-risk operative profile.