Does the distal ascending aorta and arch grow following aortic root and ascending aorta replacement?

P0108 

Abstract Submission 

Krishna Mani (1), Rajdeep Bilkhu (1), Frank Schroeder (1), Marjan Jahangiri (2)

(1) St. George's Hospital, London, NA, (2) St. George's Hospital, London, United Kingdom

Krishna Mani    -  Contact Me
St. George's Hospital

Rajdeep Bilkhu    -  Contact Me
St. George's Hospital

Frank Schroeder    -  Contact Me
St. George's Hospital

*Marjan Jahangiri    -  Contact Me
St. George's Hospital

Krishna Mani    -  Contact Me
N/A

Does the distal ascending aorta and arch grow following aortic root and ascending aorta replacement?

Krishna Mani, Rajdeep Bilkhu, Frank Schroeder, Marjan Jahangiri
Objective: We aim to assess the growth of distal ascending aorta and arch following aortic root replacement (ARR) and aortic valve replacement (AVR) + ascending aorta replacement (AAR).
Methods: A retrospective analysis of 184 consecutive patients who underwent ARR and AVR+AAR, between 2016 and 2022 was carried out (significant reduced activity during COVID). Patients with dissection and arch surgery were excluded. All patients underwent pre-operative CT scanning and follow-up at 6 months, 1 year and then annually.

Results: Of 184 patients, 60 had bicuspid aortic valve. 121 (66%) had ARR and 63 (34%) had AAR + AVR. Mean age was 60, 70% were male. Median cross-clamp and bypass times were 80 (range, 31-169) and 97 (range, 40-180) minutes, respectively. There were 2 (1.1%) in-hospital deaths. 3 (1.6%) patients had transient ischemic attacks/strokes and 3 (1.6%) had resternotomy for bleeding. Median ICU and hospital stays were 2 and 8 days, respectively. Median follow-up was of 4.3 years (1-82 months). The preoperative median ascending aorta and aortic arch diameters were 48.2 (range, 23-99) mm and 32.2 (range, 23-99) mm, respectively. The latest follow-up diameters of the distal ascending aorta were 32.4 (range, 23-41) mm and arch of 30.8 (range, 20-54) mm, respectively. No patients required surgery to the residual aorta.
In the bicuspid aortic valve subgroup, 54 (90%) had ARR and 6 (10%) had AAR + AVR. Mean age was 56 years and 90% were male. There was 1 (1.7%) in-hospital death and 1 (1.7%) patient had a TIA/stroke. The preoperative ascending aorta and aortic arch diameters were 48.2 (range, 26-65) mm and 31.2 (range, 23-49) mm respectively. The latest follow-up diameters of the distal ascending aorta were 32 (range, 27-45) mm and arch of 29.3 (range, 23-43) mm.

Conclusion: Our data does not support the practice of prophylactic arch replacement in patients undergoing ARR and AAR. The remainder of the aorta doesn't seem to grow in non-syndromic patients at four years follow-up and therefore there may not be a need for prolonged surveillance.

Aortic Arch