Aortic Root Replacement with Stentless Xenografts at Community Hospital
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0049
Submission Type:
Abstract Submission
Authors:
Jinman Cai (1), Mamata Tokala (1), W. Scott Arnold (1), Joseph Baker (1), David Wyatt (1), Joseph Rowe (1), Cynthia Choate (1), Mark Joseph (1)
Institutions:
(1) Virginia Tech Carilion School of Medicine, Roanoke, VA
Submitting Author:
Jinman Cai
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
Co-Author(s):
Mamata Tokala
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
W. Scott Arnold
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
Joseph Baker
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
David Wyatt
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
Joseph Rowe
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
Cynthia Choate
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
Mark Joseph
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Virginia Tech Carilion School of Medicine
Virginia Tech Carilion School of Medicine
Presenting Author:
Jinman Cai
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Abstract:
Objective: While use of stentless aortic bioprosthesis has become increasingly common particularly in an academic setting, there has been no comprehensive analysis of the outcomes in a large volume community hospital. Through this study, we hope to provide insight into outcomes of this procedure in a non-academic medical center setting.
Methods: This study included all patients at least 18 years of age, undergoing aortic root replacement using stentless valve from 1985 to 2021. Data were retrospectively extracted from a prospectively maintained cardiac surgical database. Stentless aortic root replacement was performed via standard median sternotomy. Baseline characteristics and operative characteristics are presented as means ± standard deviation for continuous and parametric variables, and percentage (frequency) for categorical variables. Primary outcome is 30-day mortality. Secondary outcome includes complications such as stroke, deep sternal wound infection, re-exploration for mediastinal bleeding, postoperative sepsis, pulmonary ventilation > 24 hours, pneumonia, renal failure requiring dialysis, new-onset atrial fibrillation, new pacemaker and blood products transfused. Patients were followed immediate postoperative, then 1 month, 3 month, 6 month and yearly up to 17 years with echocardiography. Logistic regression analysis was performed to assess the impact of various factors on 30-day mortality, utilizing a stepwise model to select only the variables that significant impact death rate (p < 0.2).
Results: A total of 326 patients who underwent aortic root replacement using the stentless valve were included in the study. 69 patients (21.17%) had prior cardiac or valve surgery. 132 operations (40.49%) were performed with urgent or emergent status. The mean cardiopulmonary bypass time for all patients was 227.88 ± 92.85 minutes. The mean cross-clamp time for all patients was 169.12 ± 64.72 minutes. The overall 30-day mortality was 14.72%, but that for elective case was 7.22%. For patients who underwent root replacement only without concomitant procedures, the overall 30-day mortality was 6.45% and that for elective cases was 4.55%. The most common postoperative morbidity was atrial fibrillation, with an incidence of 35.28% in overall group and 33.51% in elective group. Immediate postoperative, 1 month, 3 month, 6 month, then yearly follow-up transvalvular mean gradients were 10.11, 7.36, 6.83, 5.49, 7.59 mmHg respectively. Logistic regression analysis performed to assess the impact of various factors on 30-day mortality showed that cardiopulmonary bypass time, cross-clamp time, re-exploration for mediastinal bleeding, renal failure requiring dialysis, new-onset atrial fibrillation and concomitant Cabrol procedure placed a significant role in affecting the 30-day mortality.
Conclusions: Aortic root replacement with stentless xenografts represents a significant advancement in cardiac surgery. Their superior hemodynamic performance, favorable clinical outcomes, long-term durability, and expanding applications make them a valuable option for patients requiring aortic root replacement despite the increased technical aspects of the operation. Favorable outcomes can be achieved even in non-academic community hospitals with aortic root replacement.
Methods: This study included all patients at least 18 years of age, undergoing aortic root replacement using stentless valve from 1985 to 2021. Data were retrospectively extracted from a prospectively maintained cardiac surgical database. Stentless aortic root replacement was performed via standard median sternotomy. Baseline characteristics and operative characteristics are presented as means ± standard deviation for continuous and parametric variables, and percentage (frequency) for categorical variables. Primary outcome is 30-day mortality. Secondary outcome includes complications such as stroke, deep sternal wound infection, re-exploration for mediastinal bleeding, postoperative sepsis, pulmonary ventilation > 24 hours, pneumonia, renal failure requiring dialysis, new-onset atrial fibrillation, new pacemaker and blood products transfused. Patients were followed immediate postoperative, then 1 month, 3 month, 6 month and yearly up to 17 years with echocardiography. Logistic regression analysis was performed to assess the impact of various factors on 30-day mortality, utilizing a stepwise model to select only the variables that significant impact death rate (p < 0.2).
Results: A total of 326 patients who underwent aortic root replacement using the stentless valve were included in the study. 69 patients (21.17%) had prior cardiac or valve surgery. 132 operations (40.49%) were performed with urgent or emergent status. The mean cardiopulmonary bypass time for all patients was 227.88 ± 92.85 minutes. The mean cross-clamp time for all patients was 169.12 ± 64.72 minutes. The overall 30-day mortality was 14.72%, but that for elective case was 7.22%. For patients who underwent root replacement only without concomitant procedures, the overall 30-day mortality was 6.45% and that for elective cases was 4.55%. The most common postoperative morbidity was atrial fibrillation, with an incidence of 35.28% in overall group and 33.51% in elective group. Immediate postoperative, 1 month, 3 month, 6 month, then yearly follow-up transvalvular mean gradients were 10.11, 7.36, 6.83, 5.49, 7.59 mmHg respectively. Logistic regression analysis performed to assess the impact of various factors on 30-day mortality showed that cardiopulmonary bypass time, cross-clamp time, re-exploration for mediastinal bleeding, renal failure requiring dialysis, new-onset atrial fibrillation and concomitant Cabrol procedure placed a significant role in affecting the 30-day mortality.
Conclusions: Aortic root replacement with stentless xenografts represents a significant advancement in cardiac surgery. Their superior hemodynamic performance, favorable clinical outcomes, long-term durability, and expanding applications make them a valuable option for patients requiring aortic root replacement despite the increased technical aspects of the operation. Favorable outcomes can be achieved even in non-academic community hospitals with aortic root replacement.
Aortic Symposium:
Aortic Root
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