Hemiarch Reconstruction for Ascending Thoracic Aorta Pathology: Single-Institutional Experience
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0143
Submission Type:
Abstract Submission
Authors:
Michael Kirsch (1), Adam Carroll (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Michael Kirsch
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Michael Kirsch
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Abstract:
Objective: Hemiarch reconstruction for pathology of the ascending thoracic aorta has increased in recent years, owing to improvements in neuroprotection and surgical techniques. This has mitigated some of the additional morbidity inherent to longer cardiopulmonary bypass time and the need for circulatory arrest in performing hemiarch reconstruction, and reducing further pathological degeneration of the remaining proximal aortic arch. We sought to present our institutional experience with elective hemiarch reconstruction.
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing elective aortic arch reconstruction with a hemiarch reconstruction at a single tertiary care center from February 2011 to October 2023. Data were retrieved from the electronic medical record.
Results: Four-hundred and twenty-seven patients met the inclusion criteria. Three-hundred and twenty-seven (76.6%) were male and the median age was 62.1 (IQR 50.5 – 69.6) years. Median body mass index was 27.5 (IQR 24.4 – 31.9) and 50 (11.7%) patients had a history of diabetes. Thirty-nine (9.1%) patients had a history of previous aortic surgery. Complete patient demographic data is shown in Table 1.
Mean cardiopulmonary bypass, aortic cross clamp, and circulatory arrest time were 148 (±55.1), 104 (±47.8), and 9.97 (±6.53) minutes, respectively. Mean total length of stay was 8.32 (±5.20) days and mean intensive care unit length of stay was 3.49 (±4.18) days.
Twenty-eight (6.6%) patients experienced postoperative delirium, 11 (2.6%) experienced postoperative stroke, and 7 (1.6%) experienced postoperative seizure. Eighty-seven (20.4%) patients experienced KDIGO Grade 1 acute kidney injury (AKI) and 13 (3.0%) experienced Grade 2 or greater AKI. Ninety-six (22.5%) patients had a postoperative arrhythmia. Seven (1.6%) patients died during their postoperative hospitalization.
Conclusions: Hemiarch reconstruction is a safe and routinely performed procedure at our institution, with minimal postoperative mortality. Surgical risk should be weighed against the annual risk of complications in determining the true size criteria for elective repair.
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing elective aortic arch reconstruction with a hemiarch reconstruction at a single tertiary care center from February 2011 to October 2023. Data were retrieved from the electronic medical record.
Results: Four-hundred and twenty-seven patients met the inclusion criteria. Three-hundred and twenty-seven (76.6%) were male and the median age was 62.1 (IQR 50.5 – 69.6) years. Median body mass index was 27.5 (IQR 24.4 – 31.9) and 50 (11.7%) patients had a history of diabetes. Thirty-nine (9.1%) patients had a history of previous aortic surgery. Complete patient demographic data is shown in Table 1.
Mean cardiopulmonary bypass, aortic cross clamp, and circulatory arrest time were 148 (±55.1), 104 (±47.8), and 9.97 (±6.53) minutes, respectively. Mean total length of stay was 8.32 (±5.20) days and mean intensive care unit length of stay was 3.49 (±4.18) days.
Twenty-eight (6.6%) patients experienced postoperative delirium, 11 (2.6%) experienced postoperative stroke, and 7 (1.6%) experienced postoperative seizure. Eighty-seven (20.4%) patients experienced KDIGO Grade 1 acute kidney injury (AKI) and 13 (3.0%) experienced Grade 2 or greater AKI. Ninety-six (22.5%) patients had a postoperative arrhythmia. Seven (1.6%) patients died during their postoperative hospitalization.
Conclusions: Hemiarch reconstruction is a safe and routinely performed procedure at our institution, with minimal postoperative mortality. Surgical risk should be weighed against the annual risk of complications in determining the true size criteria for elective repair.
Aortic Symposium:
Ascending Aorta
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