Valve-Sparing Root Replacement: How Old is Too Old?
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0379
Submission Type:
Abstract Submission
Authors:
Elizabeth Norton (1), Yanhua Wang (1), Parth Patel (1), Dov Levine (2), Jose Binongo (3), Bradley Leshnower (4), Hiroo Takayama (5), Edward Chen (6)
Institutions:
(1) Emory University, Atlanta, GA, (2) Columbia University, New York, NY, (3) Emory Rollins School of Public Health, Atlanta, GA, (4) Emory University Hospital, Atlanta, GA, (5) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (6) Duke University Medical Center, Durham, NC
Submitting Author:
Elizabeth Norton
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Emory University
Emory University
Co-Author(s):
Yanhua Wang
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Emory University
Emory University
Parth Patel
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Emory University
Emory University
Dov Levine
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Columbia University
Columbia University
Jose Binongo
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Emory Rollins School of Public Health
Emory Rollins School of Public Health
*Bradley Leshnower
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Emory University Hospital
Emory University Hospital
*Hiroo Takayama
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NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
*Edward Chen
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Duke University Medical Center
Duke University Medical Center
Presenting Author:
Elizabeth Norton
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Emory University
Emory University
Abstract:
Objective: Valve-sparing root replacement (VSRR) has been shown to have excellent short- and long-term outcomes and is performed in a wide range of age into the 8th decade of life, although more often in young patients. The specific clinical factors that limit the advantages of a VSRR; however, has been understudied. This study analyzed the impact of age and preoperative comorbidities on reoperation and survival following VSRR.
Methods: From 2004-2021, in an academic database, 780 patients underwent VSRR. VSRR was performed using the David V reimplantation technique. The majority of VSRRs were performed with tailored straight tube grafts or Gelweave Valsalva graft. A discriminating age cut-off for the effect of age was determined by Contal and O'Quigley methods and patients were then divided into two groups based on age at time of surgery. Median follow-up time was 7.1 (3.3, 10.5) years with a follow-up index of 0.84.
Results: The optimal cut-off for age among patients undergoing VSRR was found to be 65 years. Sixteen percent of patients undergoing VSRR were ≥65 years at time of surgery. Overall, in-hospital mortality was 1.5% [12/780] and significantly higher among the ≥65 group (4.1% [5/123]vs 1.1% [7/657], p=0.03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between ≥65 and <65 groups (5% [95% CI: 2%, 10%] vs 6% [95% CI: 4%, 9%] p=0.28) and reoperative indications were similar between groups. Recurrence of moderate-severe aortic insufficiency was similar between ≥65 and <65 groups (14% [15/106] vs 11% [61/564], p=0.32). Overall, 10-year survival was 89% [95% CI: 85%, 91%] and significantly worse among the ≥65 group (76% [95% CI: 66%, 83%] vs 92% [95% CI: 88%, 94%], p<0.0001). Age ≥65 was an independent risk factor for late mortality (HR=5.28 [95% CI: 2.17, 12.8], p<0.001) as was longer cardiopulmonary bypass times (HR=1.01 [95% CI: 1.00, 1.02], p=0.04) and postoperative acute renal failure (HR=7.99 [95% CI: 2.24, 28.5], p<0.01).
Conclusion: Valve-sparing root replacement can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients ≥65 years old, however, aortic root replacement using a composite valve-graft conduit (ie: Bentall) should be considered due to the complexity of VSRR operations as well as worse short- and long-term survival outcomes.
Methods: From 2004-2021, in an academic database, 780 patients underwent VSRR. VSRR was performed using the David V reimplantation technique. The majority of VSRRs were performed with tailored straight tube grafts or Gelweave Valsalva graft. A discriminating age cut-off for the effect of age was determined by Contal and O'Quigley methods and patients were then divided into two groups based on age at time of surgery. Median follow-up time was 7.1 (3.3, 10.5) years with a follow-up index of 0.84.
Results: The optimal cut-off for age among patients undergoing VSRR was found to be 65 years. Sixteen percent of patients undergoing VSRR were ≥65 years at time of surgery. Overall, in-hospital mortality was 1.5% [12/780] and significantly higher among the ≥65 group (4.1% [5/123]vs 1.1% [7/657], p=0.03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between ≥65 and <65 groups (5% [95% CI: 2%, 10%] vs 6% [95% CI: 4%, 9%] p=0.28) and reoperative indications were similar between groups. Recurrence of moderate-severe aortic insufficiency was similar between ≥65 and <65 groups (14% [15/106] vs 11% [61/564], p=0.32). Overall, 10-year survival was 89% [95% CI: 85%, 91%] and significantly worse among the ≥65 group (76% [95% CI: 66%, 83%] vs 92% [95% CI: 88%, 94%], p<0.0001). Age ≥65 was an independent risk factor for late mortality (HR=5.28 [95% CI: 2.17, 12.8], p<0.001) as was longer cardiopulmonary bypass times (HR=1.01 [95% CI: 1.00, 1.02], p=0.04) and postoperative acute renal failure (HR=7.99 [95% CI: 2.24, 28.5], p<0.01).
Conclusion: Valve-sparing root replacement can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients ≥65 years old, however, aortic root replacement using a composite valve-graft conduit (ie: Bentall) should be considered due to the complexity of VSRR operations as well as worse short- and long-term survival outcomes.
Aortic Symposium:
Aortic Root
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