Association of Metachronous Aortic Procedures to Operative Mortality and Survival in a Quaternary Referral Center: 5013 operations in 4500 patients.

P0064 

Abstract Submission 

Ivancarmine Gambardella (1), berhane worku (2), Christopher Lau (3), Robert Tranbaugh (4), Sandhya Balaram (5), Leonard Girardi (4)

(1) Weill Cornell Medical Center, New York, NY, (2) Weil Cornell Medical College, Brooklyn, NY, (3) New York Presbyterian-Weill Cornell, New York, NY, (4) Weill Cornell Medicine, New York, NY, (5) Mount Sinai, New York, United States

Ivancarmine Gambardella    -  Contact Me
Weill Cornell Medical Center

*Berhane Worku    -  Contact Me
Weil Cornell Medical College

*Christopher Lau    -  Contact Me
New York Presbyterian-Weill Cornell

Robert Tranbaugh    -  Contact Me
Weill Cornell Medicine

*Sandhya Balaram    -  Contact Me
Mount Sinai

*Leonard Girardi    -  Contact Me
Weill Cornell Medicine

Ivancarmine Gambardella    -  Contact Me
Weill Cornell Medical Center

Objective – Quaternary referral centers perform metachronous operations on the same (reoperations) or on different (reinterventions) aortic segments. We aimed to discern the association of metachrony to operative mortality (OM) and survival after thoracic aortic surgery.
Methods – Our cohort was our institutional series (07/1996 - 10/2023). Aortic segment classification: segment I (ascending aorta ± root), segment II (segment I + total/hemi arch), segment III (descending thoraco-abdominal aorta). In survival analysis, index operations (the 1st aortic procedures performed) were dichotomized in proximal (segment I + II) and distal (segment III). Kaplan-Meier with Log Rank test survival analysis was performed.
Results – Relevant information was available on 4500 patients (655, 14% previously operated elsewhere), who underwent 5013 aortic procedures: 2284 (45.6%) on segment I, 1642 (32.7%) on segment II, 1087 (21.7%) on segment III. OM for segment I: initial operation 10/2129 (0.5%); 1st reoperation 2/136 (1.5%), 2nd reoperation 0/18 (0.0%), 3rd reoperation 0/1 (0.0%). OM for segment II: initial operation 42/1485 (2.9%), 1st reoperation 6/131 (4.6%), 2nd reoperation 0/26 (0.0%). OM for segment III: initial operation 35/775 (4.5%), 1st reoperation 11/277 (3.8%), 2nd reoperation 0/31 (0.0%), 3rd reoperation 0/2 (0.0%), 4th reoperation 0/2 (0.0%). Of the 2473 patients undergone a segment I index operation, subsequently 4 (0.2%) had segment II, 23 (0.9%) had segments III, and 32 (1.3%) had segments II and III procedures. Of the 1301 patients undergone a segment II index operation, subsequently 5 (0.4%) had segment I and 92 (7.1%) had segment III procedures. Of the 726 patients undergone a segment III index operation, subsequently 21 (2.9%) had segment I, 52 (7.2%) had segment III, and 1 (0.1%) had segment I and II procedures. Reoperations on the proximal aorta were not associated to survival (p 0.12). Reoperations on the distal aorta were associated to decreased survival (p < 0.01). After proximal index procedure, distal reinterventions were associated to decreased survival (p < 0.01). After distal index procedure, patients who underwent proximal reintervention had an increased survival (p < 0.01).
Conclusion – Metachronous aortic procedures can be performed with low OM in a quaternary center. Of all metachronous procedures, only reinterventions on the proximal aorta after distal index operation are associated to a survival benefit.

Natural History/Follow-Up