Mid-term outcomes of Y incision annular root enlargement compared to traditional root enlargement techniques.
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0212
Submission Type:
Abstract Submission
Authors:
Fatima Qamar (1), Sahar Samimi (2), Marcel Gugala (2), Muskan Khan (2), Ahmed Ahmed (2), Taha Hatab (2), Rody Bou Chaaya (2), Neal Kleiman (2), Sachin Goel (3), Syed Zaid (4), Ross Reul (2), Mahesh Ramchandani (2), Michael Reardon (2), Marvin Atkins (2)
Institutions:
(1) N/A, N/A, (2) Houston Methodist Hospital, Houston, TX, (3) Houston Methodist, N/A, (4) Houston Methodist Debakey Heart and Vascular Center, Houston, TX
Submitting Author:
Fatima Qamar
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Co-Author(s):
Sahar Samimi
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Houston Methodist Hospital
Houston Methodist Hospital
Marcel Gugala
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Houston Methodist Hospital
Houston Methodist Hospital
Muskan Khan
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Houston Methodist Hospital
Houston Methodist Hospital
Ahmed Ahmed
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Houston Methodist Hospital
Houston Methodist Hospital
Taha Hatab
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Houston Methodist Hospital
Houston Methodist Hospital
Rody Bou Chaaya
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Houston Methodist Hospital
Houston Methodist Hospital
Neal Kleiman
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Houston Methodist Hospital
Houston Methodist Hospital
Sachin Goel
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Houston Methodist
Houston Methodist
Syed Zaid
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Houston Methodist Debakey Heart and Vascular Center
Houston Methodist Debakey Heart and Vascular Center
Ross Reul
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Houston Methodist Hospital
Houston Methodist Hospital
Mahesh Ramchandani
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Houston Methodist Hospital
Houston Methodist Hospital
*Michael Reardon
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Houston Methodist Hospital
Houston Methodist Hospital
Marvin Atkins
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Houston Methodist Hospital
Houston Methodist Hospital
Presenting Author:
Fatima Qamar
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Abstract:
Objective:
Patient prosthesis mismatch remains a significant problem following surgical aortic valve replacement in up to half the patients, affecting long-term valve durability and outcomes. The Y-incision root enlargement technique was recently proposed to enlarge the annulus by 3-4 valve sizes. We compare our early results using this technique with traditional root enlargement (Nicks or Manougian).
Methods:
From 2017-2023, we retrospectively reviewed our institutional cardiac surgery database, patient medical records, and internal surgical valve database to compare all patients undergoing root enlargement operations with or without other combined cardiac operations. Patients were categorized based on the operative techniques. Patient demographics, procedural characteristics, and operative outcomes were reported at 30 days and one year between the two groups. Multivariable Cox proportional hazards regression was used to investigate the association between one-year mortality and root enlargement techniques.
Results:
Among the 111 patients in our cohort, 60 underwent the traditional, and 51 underwent Y-incision root enlargement. The mean age was 64.7±11.8 years; 68% (76/111) were females, and (29/111) 26% had a prior surgical aortic valve replacement. Most operations (95%) employed a sternotomy, with 78% receiving a bioprosthetic valve and 22% a mechanical valve. Isolated AVR was performed in 69% (77/111) of the cohort. Patients undergoing Y-incision annuloplasty had a higher prevalence of endocarditis (18%(9/51) vs 2%(1/60), p<0.003), former sternotomy (33% (17/51) vs 23%(14/60)), and prior MI (16%(8/51) vs 5%(3/60)) compared to the traditional group. Compared to the traditional group, the increase in implanted valve size was significantly higher in the Y-incision group, 4.1mm compared to 2.6mm (p<0.001), an aortic cross-clamp time of 135 min versus 105 min (p:<0.001), and a cardiopulmonary bypass time of 182 min versus 130 minutes(p<0.001). Overall, 30-day post-operative complications were not statistically different between the two groups. The postoperative mean gradient across the aortic valve was 8.1mmHg in the traditional group and 10.1mmHg in the Y enlargement group (p=0.23). Similarly, the effective orifice area was 1.8cm2 in the Y-incision group compared to 1.6cm2 in the traditional group (p=0.05). Multivariable analysis, adjusting for age, gender, endocarditis, and prior MI, showed no significant difference in mortality hazards at 30 days (p:0.14) and one year (p:0.26) between the two procedures.
Conclusions:
Our experience with 51 patients undergoing Y root enlargement shows similar perioperative outcomes after adjusting for comorbidities compared to traditional root enlargement techniques. The Y enlargement cohort was associated with a longer operative time and a more significant increase in aortic valve size. Further investigations are warranted to validate these early results and assess long-term effects.
Patient prosthesis mismatch remains a significant problem following surgical aortic valve replacement in up to half the patients, affecting long-term valve durability and outcomes. The Y-incision root enlargement technique was recently proposed to enlarge the annulus by 3-4 valve sizes. We compare our early results using this technique with traditional root enlargement (Nicks or Manougian).
Methods:
From 2017-2023, we retrospectively reviewed our institutional cardiac surgery database, patient medical records, and internal surgical valve database to compare all patients undergoing root enlargement operations with or without other combined cardiac operations. Patients were categorized based on the operative techniques. Patient demographics, procedural characteristics, and operative outcomes were reported at 30 days and one year between the two groups. Multivariable Cox proportional hazards regression was used to investigate the association between one-year mortality and root enlargement techniques.
Results:
Among the 111 patients in our cohort, 60 underwent the traditional, and 51 underwent Y-incision root enlargement. The mean age was 64.7±11.8 years; 68% (76/111) were females, and (29/111) 26% had a prior surgical aortic valve replacement. Most operations (95%) employed a sternotomy, with 78% receiving a bioprosthetic valve and 22% a mechanical valve. Isolated AVR was performed in 69% (77/111) of the cohort. Patients undergoing Y-incision annuloplasty had a higher prevalence of endocarditis (18%(9/51) vs 2%(1/60), p<0.003), former sternotomy (33% (17/51) vs 23%(14/60)), and prior MI (16%(8/51) vs 5%(3/60)) compared to the traditional group. Compared to the traditional group, the increase in implanted valve size was significantly higher in the Y-incision group, 4.1mm compared to 2.6mm (p<0.001), an aortic cross-clamp time of 135 min versus 105 min (p:<0.001), and a cardiopulmonary bypass time of 182 min versus 130 minutes(p<0.001). Overall, 30-day post-operative complications were not statistically different between the two groups. The postoperative mean gradient across the aortic valve was 8.1mmHg in the traditional group and 10.1mmHg in the Y enlargement group (p=0.23). Similarly, the effective orifice area was 1.8cm2 in the Y-incision group compared to 1.6cm2 in the traditional group (p=0.05). Multivariable analysis, adjusting for age, gender, endocarditis, and prior MI, showed no significant difference in mortality hazards at 30 days (p:0.14) and one year (p:0.26) between the two procedures.
Conclusions:
Our experience with 51 patients undergoing Y root enlargement shows similar perioperative outcomes after adjusting for comorbidities compared to traditional root enlargement techniques. The Y enlargement cohort was associated with a longer operative time and a more significant increase in aortic valve size. Further investigations are warranted to validate these early results and assess long-term effects.
Aortic Symposium:
Aortic Root
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