Aortic Root Replacement in Adult Patients with Repaired Congenital Conotruncal Defects - Procedures, Hospital Survival, Risk Factors A European Congenital Heart Surgeons Association (ECHSA) Database Study.

Kari, FA, Sarris, G, Lotto, A ORCID: 0000-0002-8922-6107, Pätilä, T, Asfour, B, Eleftherios, P, Tobota, Z, Padalino, M, Kansy, A, Speggiorin, S, Vida, V, Arrigoni, SC, Jacobs, JP, Lo Rito, M, Van Puyvelde, J, Ebels, T and Hörer, J (2026) Aortic Root Replacement in Adult Patients with Repaired Congenital Conotruncal Defects - Procedures, Hospital Survival, Risk Factors A European Congenital Heart Surgeons Association (ECHSA) Database Study. The Journal of Thoracic and Cardiovascular Surgery. ISSN 0022-5223

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Abstract

Objectives
To characterize hospital survival and risk factors after aortic root replacement performed by congenital units in adult patients, and to compare risk profiles of repaired conotruncal defects to other underlying diagnoses.

Methods
Adult patients after aortic root replacement in a congenital cardiac unit were identified in the European Congenital Heart Surgeons Association (ECHSA) database. Underlying pathology, prior surgeries, and types of index aortic root surgery were characterized. Primary endpoints were hospital and 30-day survival. Secondary endpoints 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.

Results
N=2544 patients after full aortic root replacement, performed in 101 different hospitals (1999 to 2024), were identified. N=249 patients (10%) with primary conotruncal defects included double-outlet-right ventricle (n=14, 6%), pulmonary atresia with VSD (n=42, 17%), transposition of great arteries (n=71, 29%), Tetralogy of Fallot (n=88, 35%), Truncus arteriosus communis (n=34, 14%). Mechanical Bentall was performed in n=163 cases (65%), valve-sparing in n=43 cases (17%), biological Bentall in n=20 (8%), homograft replacement in n=23 (9%). Conotruncal diagnosis was linked to longer CPB times (p<0.001), longer aortic cross-clamp times (p<0.001), longer ICU stay (p<0.001) and longer hospital stay (p<0.001). Multiple logistic regression revealed duration of CPB (p<0.001) and conotruncal lesion (OR 2.1, p=0.037) as independent risk factors for hospital mortality.

Conclusions
Among adult congenital heart defect patients undergoing aortic root replacement, those with conotruncal defects represent a distinct subgroup characterized by a high-risk operative profile.

Item Type:	Article
Uncontrolled Keywords:	aortic root replacement; congenital heart disease; conotruncal malformation; 32 Biomedical and Clinical Sciences; 3201 Cardiovascular Medicine and Haematology; 3202 Clinical Sciences; Congenital Structural Anomalies; Patient Safety; Heart Disease; Pediatric Research Initiative; Congenital Heart Disease; Rare Diseases; Cardiovascular; Infant Mortality; Cardiovascular; 1102 Cardiorespiratory Medicine and Haematology; 1103 Clinical Sciences; Respiratory System; 3201 Cardiovascular medicine and haematology; 3202 Clinical sciences
Subjects:	R Medicine > RD Surgery R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Publisher:	Elsevier
Date of acceptance:	19 May 2026
Date of first compliant Open Access:	10 August 2026
Date Deposited:	10 Aug 2026 09:51
Last Modified:	10 Aug 2026 09:51
DOI or ID number:	10.1016/j.jtcvs.2026.05.029
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29133

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