Objective - The aim was to evaluate early and long-term outcomes of re-sternotomy for aortic valve replacement with previous patent coronary artery grafts. Methods - Data for re-sternotomy for aortic valve replacements (group 1 isolated AVR, group 2 AVR with concomitant procedure) were collected (2000-19). Logistic regression analysis was performed to identify predictors of in-hospital mortality and postoperative composite outcome (in-hospital death, TIA/stroke, renal failure requiring new hemofiltration, deep sternal wound infection, re-exploration for bleeding/tamponade and length of stay >30 days). Survival curves were compared using log rank test. Cox proportion hazards model was used for predictors of long term survival. Results – Total 178 patients were included (groups 1 - 90 patients, group 2 - 88 patients). Mean age was 75±4 years and mean log EuroSCORE was 17±12% (15 ± 8% - group 1 vs 19 ± 14% - group 2, p=0.06). Mean follow up was 6.3±4.4 years. Cardiovascular injury occurred in 12%. LIMA was most commonly injured. In-hospital mortality was 7.8% (5% - group 1 versus 10.2% - group 2, p=0.247). NYHA class III-IV, perioperative IABP and cardiovascular injury were independent predictors of in-hospital mortality (HR; 13.33, 95% CI; 2.04, 83.33, p=0.007). Survival was significantly worse with cardio-vascular injury at re-sternotomy up to 5 years (46% versus 67%, p=0.025) and postoperative complications (p=0.023). Survival was significantly lower than age matched first time AVR and UK population. Conclusions – Long term survival is significantly impaired by cardiovascular injury and perioperative complications of re-sternotomy.

Introduction - The impact of manufacturer labelled prosthesis size and predicted effective orifice area (EOA) on long term survival after aortic valve replacement is not clear although indexed effective orifice area (iEOA) has been associated with worse survival. Methods - Data was retrospectively collected from Jan 2000 – Dec 2019 for prosthesis type, model and size for isolated aortic valve replacements. Stratified survival was compared between groups and subgroups for labelled valve size, EOA and predicted PPM. Results – Total of 3444 patients were included. Moderate and severe PPM was 15.6% and 1.6% respectively. Cumulative life time hazard was worse for biological valves (mortality: biological 77.7% vs mechanical 64.8%, p=0.001). Mean survival was 132.7 months for biological versus 191.3 months for mechanical valves (p=0.001). Moderate prosthetic AS (EOA = 1-1.5 cm2) was12.1% and severe prosthetic AS (EOA≤1 cm2) was 0.8% respectively. Worse survival in the presence of moderate-severe prosthetic AS was seen in biological valves (115.2 months versus 133.7 months, p=0.001 for EOA≤1.5cm2 and >1.5cm2 respectively). There was a statistically significant correlation between survival and iEOA (Spearman’s rho=0.084, p=0.001, BCa bootstrap 95% CI;0.050, 0.120). Moderate to severe PPM (iEOA≤0.85cm2/m2) was a predictor of worse long term survival (HR 3.56; 95% CI: 1.37 - 9.25; p=0.009). Conclusion - Predicted prosthetic moderate to severe AS and moderate to severe PPM adversely affect long term survival. Smaller valves are associated with reduced survival in all groups.