Early and long-term outcomes of conventional and valve-sparing aortic root replacement

P0114 

Abstract Submission 

Krishna Mani (1), Robert Morgan (1), Mark Edsell (1), Maria Teresa Tome Esteban (1), Frank Schroeder (1), Marjan Jahangiri (2)

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

Krishna Mani    -  Contact Me
St George's, University of London

Robert Morgan    -  Contact Me
St George's, University of London

Mark Edsell    -  Contact Me
St George's, University of London

Maria Teresa Tome Esteban    -  Contact Me
St George's, University of London

Frank Schroeder    -  Contact Me
St George's, University of London

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

Krishna Mani    -  Contact Me
N/A

Title: Early and long-term outcomes of conventional and valve-sparing aortic root replacement

Objective: We aim to determine the early and long-term outcomes of conventional aortic root (ARR) and valve sparing root replacement (VSRR). VSRR were performed using the remodeling technique.

Methods: We present prospectively collected data of 641 consecutive patients undergoing elective and urgent aortic root surgery (498 ARR, 143 VSRR) between 2006 and 2022. All patients underwent pre-operative echocardiogram and CT scanning and follow-up at 6 months, 1 year and then annually. Younger patients with syndromes underwent genetic analysis. Patients with aortic diameters of >4.5 cm were referred for surgery. Primary outcomes were operative mortality and incidence of postoperative complications. Secondary outcomes were long-term survival and requirement for re-intervention. Median follow-up was 7.8 years (range, 0.5–14.5).

Results: 203 (32%) patients had bicuspid aortic valves, 143 (22%) had a connective tissue disease and 18 (2.8%) underwent redo procedures. Median cross-clamp time was 88 (ARR 71, VSRR 115; [range 54–208]) minutes with cardiopulmonary bypass of 107 (ARR 82, VSRR 137; [range 75–296]) minutes. In the patients undergoing ARR, 314 (63%) patients had tissue ARR, 181 (36%) had mechanical ARR, 3 (0.6%) had ARR with a homograft and 84 (17%) had a concomitant procedure. In-hospital mortality was 11 (1.7%) (ARR [2.0%]; VSRR [0.7%]), with transient ischemic attacks/strokes occurring in 7 ARR patients (1.1%). 13 (2.0%) (ARR [2.4%]; VSRR [0.7%]) required a re-sternotomy for bleeding and 14 (2.8%) received hemofiltration. 6 (0.9%) (ARR [1.0%]; VSRR [2.0%]) required permanent pacemaker implantation. Intensive care unit and hospital stays were 1.7 and 7.0 days respectively. During follow-up, redo surgery for native aortic valve replacement was required in 2 (1.4%) of the VSRR group due to greater than moderate aortic valve incompetence.

Conclusions: ARR and VSRR can be performed with low mortality and morbidity as well as a low rate of re-intervention during long-term follow-up, if performed by an experienced team with a consistent perioperative approach. This series provides contemporary evidence of how to balance the risks of aortic aneurysms and the risk of rupture at diameters of 4.5 cm against the risks and benefits of surgery.

Aortic Root