Importance of Surgeon’s Volume in Practicing Valve-Sparing Aortic Root Replacement
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0165
Submission Type:
Abstract Submission
Authors:
Kavya Rajesh (1), Megan Chung (2), Dov Levine (3), Elizabeth Norton (4), Parth Patel (4), Yu Hohri (5), Christopher He (1), Paridhi Agarwal (4), Yanling Zhao (6), Pengchen Wang (7), Paul Kurlansky, MD (8), Edward Chen (9), Hiroo Takayama (10)
Institutions:
(1) N/A, N/A, (2) Columbia University Irving Medical Center, N/A, (3) Columbia University, New York, NY, (4) Emory University, Atlanta, GA, (5) Columbia University Irving Medical Center, New York, NY, (6) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (7) Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, (8) Columbia University Medical Center, New York, NY, (9) Duke University Medical Center, Durham, NC, (10) NewYork- Presbyterian/Columbia University Medical Center, New York, NY
Submitting Author:
Kavya Rajesh
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Co-Author(s):
Megan Chung
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Dov Levine
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Columbia University
Columbia University
Elizabeth Norton
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Emory University
Emory University
Parth Patel
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Emory University
Emory University
Yu Hohri
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Christopher He
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N/A
N/A
Paridhi Agarwal
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Emory University
Emory University
Yanling Zhao
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NewYork-Presbyterian Columbia University Irving Medical Center
NewYork-Presbyterian Columbia University Irving Medical Center
Pengchen Wang
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Center for Innovation and Outcomes Research, Department of Surgery, Columbia University
Center for Innovation and Outcomes Research, Department of Surgery, Columbia University
*Paul Kurlansky, MD
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Columbia University Medical Center
Columbia University Medical Center
*Edward Chen
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Duke University Medical Center
Duke University Medical Center
*Hiroo Takayama
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NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Presenting Author:
Kavya Rajesh
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Abstract:
Objective: Aortic root replacement (ARR), particularly valve-sparing root replacement (VSRR) is a challenging procedure requiring technical proficiency. This study aims to examine the influence of surgeon volume on practicing VSRR.
Methods: This is retrospective study of 1607 patients from two large aortic centers who underwent ARR from 2004 to 2021 and were potentially eligible for VSRR. Patients with moderate/severe aortic stenosis, prior aortic valve procedure, surgical indication for endocarditis or valvular dysfunction, and Ross/Homograft root replacements were excluded. Surgeons were classified as having performed <5 ARR or ≥5 ARR annually. Multivariable logistic regression was used to examine the independent association of surgeon volume and performing VSRR. Inverse probability treatment weighting (IPTW) was used to match patients who were operated on by <5 ARR or ≥5 ARR surgeons to determine their differences in postoperative clinical outcomes. Cumulative incidence curves with mortality as a competing risk were plotted to compare the rate of aortic valve reoperation in <5 ARR or ≥5 ARR surgeons.
Results: Of 1607 patients who met inclusion criteria, 884 patients underwent composite-valved conduit and 723 underwent VSRR. The median age of our cohort was 57 [45-66] years old and 257 (16.0%) were female. Aortic insufficiency was present in 1020 (63.5%) of patients and 188 (11.7%) of cases were a reoperation. Surgical indication was aneurysm in 1413 (87.9%) and dissection in 194 (12.1%) of patients. Among VSRR operations, 666 patients were operated on by ≥5 ARR surgeons and 57 patients were operated on by <5 ARR surgeons (Figure 1a). Of 57 VSRR performed by <5 ARR surgeons, 23 (40%) were assisted by an ≥5 ARR surgeon. In multivariable logistic regression, ≥5 ARR (OR: 3.48, 95% CI: 2.42-5.00, p <0.001) was associated with VSRR as a procedure of choice. Following IPTW, there was no significant difference in outcomes after VSRR between <5 ARR and ≥5 ARR surgeons (p = 0.8) (Figure 1b). There was also no significant difference in the rate of aortic valve reoperation between the two groups (p = 0.7).
Conclusions: In the context of a high-volume aortic center, patients who undergo ARR are less likely to receive VSRR if operated on by a <5 ARR surgeon; however, VSRR may be safely performed by a <5 ARR surgeon.
Methods: This is retrospective study of 1607 patients from two large aortic centers who underwent ARR from 2004 to 2021 and were potentially eligible for VSRR. Patients with moderate/severe aortic stenosis, prior aortic valve procedure, surgical indication for endocarditis or valvular dysfunction, and Ross/Homograft root replacements were excluded. Surgeons were classified as having performed <5 ARR or ≥5 ARR annually. Multivariable logistic regression was used to examine the independent association of surgeon volume and performing VSRR. Inverse probability treatment weighting (IPTW) was used to match patients who were operated on by <5 ARR or ≥5 ARR surgeons to determine their differences in postoperative clinical outcomes. Cumulative incidence curves with mortality as a competing risk were plotted to compare the rate of aortic valve reoperation in <5 ARR or ≥5 ARR surgeons.
Results: Of 1607 patients who met inclusion criteria, 884 patients underwent composite-valved conduit and 723 underwent VSRR. The median age of our cohort was 57 [45-66] years old and 257 (16.0%) were female. Aortic insufficiency was present in 1020 (63.5%) of patients and 188 (11.7%) of cases were a reoperation. Surgical indication was aneurysm in 1413 (87.9%) and dissection in 194 (12.1%) of patients. Among VSRR operations, 666 patients were operated on by ≥5 ARR surgeons and 57 patients were operated on by <5 ARR surgeons (Figure 1a). Of 57 VSRR performed by <5 ARR surgeons, 23 (40%) were assisted by an ≥5 ARR surgeon. In multivariable logistic regression, ≥5 ARR (OR: 3.48, 95% CI: 2.42-5.00, p <0.001) was associated with VSRR as a procedure of choice. Following IPTW, there was no significant difference in outcomes after VSRR between <5 ARR and ≥5 ARR surgeons (p = 0.8) (Figure 1b). There was also no significant difference in the rate of aortic valve reoperation between the two groups (p = 0.7).
Conclusions: In the context of a high-volume aortic center, patients who undergo ARR are less likely to receive VSRR if operated on by a <5 ARR surgeon; however, VSRR may be safely performed by a <5 ARR surgeon.
Aortic Symposium:
Aortic Root
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