Impact of Associated Procedures on Long-Term Outcomes in Valve-Sparing Aortic Root Replacement: A Propensity Score Matched Analysis
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0153
Submission Type:
Abstract Submission
Authors:
Andres Jimenez (1), Carlos Villa (2), Lina Ramírez (3), Ivonne Pineda (3), Julian Senosiain (4), Carlos Obando (5), TOMAS Chalela (6), NESTOR SANDOVAL (7), Jaime Camacho (8), Juan Umaña (9)
Institutions:
(1) Fundacion Cardioinfantil / La Cardio - Universidad del Rosario, Bogota, DC, (2) Fundacion Cardioinfantil, Bogota, Colombia, (3) La Cardio, Bogota, NA, (4) N/A, N/A, (5) N/A, Bogota, Colombia, (6) N/A, bogota, Colombia, (7) FUNDACION CARDIOINFANTIL, BOGOTA, DC, (8) Fundación CardioInfantil, Bogota, NA, (9) La Cardio, Bogota
Submitting Author:
Andres Jimenez
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Fundacion Cardioinfantil / La Cardio - Universidad del Rosario
Fundacion Cardioinfantil / La Cardio - Universidad del Rosario
Co-Author(s):
Carlos Villa
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Fundacion Cardioinfantil
Fundacion Cardioinfantil
Lina Ramírez
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La Cardio
La Cardio
Ivonne Pineda
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La Cardio
La Cardio
Julian Senosiain
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N/A
N/A
Carlos Obando
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N/A
N/A
TOMAS Chalela
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N/A
N/A
NESTOR SANDOVAL
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FUNDACION CARDIOINFANTIL
FUNDACION CARDIOINFANTIL
Jaime Camacho
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Fundación CardioInfantil
Fundación CardioInfantil
*Juan P. Umaña
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La Cardio
La Cardio
Presenting Author:
Andres Jimenez
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Fundacion Cardioinfantil / La Cardio - Universidad del Rosario
Fundacion Cardioinfantil / La Cardio - Universidad del Rosario
Abstract:
Objective: Aortic valve-sparing aortic root replacement (VSARR) is accepted as an excellent option for patients with isolated aortic root pathology. This study aims to compare outcomes between patients undergoing isolated VSARR and those undergoing VSARR with associated procedures.
Methods: We conducted a retrospective analysis of 171 patients who underwent VSARR, with 115 patients in the isolated procedure (IP) group and 56 patients in the associated procedures (AP) group. A propensity score matching (PSM) was employed to create 40 well-matched pairs. Patient characteristics, including sex, age, comorbidities, and clinical parameters were used to calculate propensity scores. Outcome measures were compared before and after PSM. The Kaplan-Meier method was used to establish long-term survival and freedom from valve-related reintervention.
Results: Prior to PSM, AP patients had a higher proportion of preoperative myocardial infarction (0% vs. 10.7%; p=0.001), atrial fibrillation (0.9% vs. 7.1%; p=0.04), higher EuroSCORE (median 4% vs. 5%; p=0.002), and worse NYHA functional class (8.7% vs. 21.5% in functional class III and IV; p=0.019). After PSM, a homogeneous sample was obtained. Postoperatively, statistically significant differences were found for the duration of cardiopulmonary bypass (median 190 min vs. 220 min; p=0.001), aortic cross-clamp (median 166 min vs. 193 min; p=0.005), length of ICU stay (median, days: 1 vs. 2.8; p=0.003), and postoperative hospital stay (median, days: 5 vs. 6.5; p=0.032), all greater in AP patients. The overall follow-up time median was 7.2 years. No significant differences were found in short- and long-term outcomes such as mortality, reoperation for bleeding, clinical stroke, cardiac arrest, and atrial fibrillation, both before and after PSM. Moreover, we found no difference in valve-related reintervention (Log Rank=0.932) and survival (Log Rank=0.259) at long-term follow-up.
Conclusion: In patients undergoing VSARR, the addition of associated procedures appears to be associated with increased surgical complexity and longer recovery times. However, these differences do not translate into increased postoperative morbidity and mortality. Further research is needed to explore the long-term outcomes in this patient population.
Methods: We conducted a retrospective analysis of 171 patients who underwent VSARR, with 115 patients in the isolated procedure (IP) group and 56 patients in the associated procedures (AP) group. A propensity score matching (PSM) was employed to create 40 well-matched pairs. Patient characteristics, including sex, age, comorbidities, and clinical parameters were used to calculate propensity scores. Outcome measures were compared before and after PSM. The Kaplan-Meier method was used to establish long-term survival and freedom from valve-related reintervention.
Results: Prior to PSM, AP patients had a higher proportion of preoperative myocardial infarction (0% vs. 10.7%; p=0.001), atrial fibrillation (0.9% vs. 7.1%; p=0.04), higher EuroSCORE (median 4% vs. 5%; p=0.002), and worse NYHA functional class (8.7% vs. 21.5% in functional class III and IV; p=0.019). After PSM, a homogeneous sample was obtained. Postoperatively, statistically significant differences were found for the duration of cardiopulmonary bypass (median 190 min vs. 220 min; p=0.001), aortic cross-clamp (median 166 min vs. 193 min; p=0.005), length of ICU stay (median, days: 1 vs. 2.8; p=0.003), and postoperative hospital stay (median, days: 5 vs. 6.5; p=0.032), all greater in AP patients. The overall follow-up time median was 7.2 years. No significant differences were found in short- and long-term outcomes such as mortality, reoperation for bleeding, clinical stroke, cardiac arrest, and atrial fibrillation, both before and after PSM. Moreover, we found no difference in valve-related reintervention (Log Rank=0.932) and survival (Log Rank=0.259) at long-term follow-up.
Conclusion: In patients undergoing VSARR, the addition of associated procedures appears to be associated with increased surgical complexity and longer recovery times. However, these differences do not translate into increased postoperative morbidity and mortality. Further research is needed to explore the long-term outcomes in this patient population.
Aortic Symposium:
Aortic Root
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