Pulmonary Artery Injury is Inconsequential in Re-do Aortic Arch Surgery
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0272
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Nicolas Chanes (1), Ananya Shah (1), Zihan Feng (1), Michal Schafer (1), Kelly Higa (1), Jintong Liu (1), Jacob Edwards (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Nicolas Chanes
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University of Colorado Anschutz
University of Colorado Anschutz
Ananya Shah
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University of Colorado Anschutz
University of Colorado Anschutz
Zihan Feng
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University of Colorado Anschutz
University of Colorado Anschutz
Michal Schafer
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University of Colorado Anschutz
University of Colorado Anschutz
Kelly Higa
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University of Colorado Anschutz
University of Colorado Anschutz
Jintong Liu
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University of Colorado Anschutz
University of Colorado Anschutz
Jacob Edwards
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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:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective: Re-intervention of the aorta poses a technical challenge and risk of iatrogenic injury to surrounding structures due to significant scar tissue. The pulmonary arteries (PA) are at particular risk for injury, especially in distal ascending interventions. We hypothesize that when a PA injury does occur, if recognized and repaired at the time of surgery, patients are not at risk for adverse postoperative outcomes.
Methods: All patients who underwent re-do sternotomy for aortic arch or root intervention in our single institution prospectively maintained database between February 2010 and December 2023 were reviewed. In total, 238 patients were identified for analysis. Patients were stratified into two cohorts based on whether PA injury occurred. Pre-, intra- and post-operative outcomes were analyzed.
Results: Of the 238 patients who underwent re-do sternotomy for aortic intervention, 34 (14.3%) required PA repair and 204 (85.7%) did not require PA repair. Patients who underwent PA repair were more likely to undergo more extensive aortic intervention (p<0.001), with the majority occurring in total arch replacement (70.6%). Notably, patients who required PA repair had significantly longer cardiopulmonary bypass time (p<0.001), cross clamp time (p=0.014) and circulatory arrest time (p<0.001). When separated by procedure type, significant differences remained in total arch cardiopulmonary bypass time and cross-clamp time, but not with circulatory arrest time. No significant difference was present in any of the three times for hemiarch repair, however, the total number of PA injuries in hemiarch was small (N=7). PA injury was associated with greater administration of intra-operative FFP, but not other blood products. PA injury was not associated with any significant difference in post-operative outcomes, including risk of open chest or take back for bleeding, blood product transfusion, hospital or ICU length of stay, and post operative morbidity or mortality.
Conclusions: PA injury in re-do sternotomy is a common injury, that is more likely to occur with more extensive & complex aortic reinterventions. PA injury is significantly associated with longer cardiopulmonary bypass times and aortic cross clamp times in total arches, but not hemiarches, likely reflective of the more extensive tissue dissection required in total arches. However, when PA injury occurs and is recognized it does not increase the risk of post-operative morbidity or mortality.
Methods: All patients who underwent re-do sternotomy for aortic arch or root intervention in our single institution prospectively maintained database between February 2010 and December 2023 were reviewed. In total, 238 patients were identified for analysis. Patients were stratified into two cohorts based on whether PA injury occurred. Pre-, intra- and post-operative outcomes were analyzed.
Results: Of the 238 patients who underwent re-do sternotomy for aortic intervention, 34 (14.3%) required PA repair and 204 (85.7%) did not require PA repair. Patients who underwent PA repair were more likely to undergo more extensive aortic intervention (p<0.001), with the majority occurring in total arch replacement (70.6%). Notably, patients who required PA repair had significantly longer cardiopulmonary bypass time (p<0.001), cross clamp time (p=0.014) and circulatory arrest time (p<0.001). When separated by procedure type, significant differences remained in total arch cardiopulmonary bypass time and cross-clamp time, but not with circulatory arrest time. No significant difference was present in any of the three times for hemiarch repair, however, the total number of PA injuries in hemiarch was small (N=7). PA injury was associated with greater administration of intra-operative FFP, but not other blood products. PA injury was not associated with any significant difference in post-operative outcomes, including risk of open chest or take back for bleeding, blood product transfusion, hospital or ICU length of stay, and post operative morbidity or mortality.
Conclusions: PA injury in re-do sternotomy is a common injury, that is more likely to occur with more extensive & complex aortic reinterventions. PA injury is significantly associated with longer cardiopulmonary bypass times and aortic cross clamp times in total arches, but not hemiarches, likely reflective of the more extensive tissue dissection required in total arches. However, when PA injury occurs and is recognized it does not increase the risk of post-operative morbidity or mortality.
Aortic Symposium:
Aortic Arch
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