Alternative Surgical Management for Patients Requiring Complex Cardiac Procedures but Unable to Receive Blood Products
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0035
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Ananya Shah (1), Muhammad Aftab (1), Donald Jacobs (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):
Ananya Shah
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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
Donald Jacobs
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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:
Ananya Shah
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective
Patients who are unable to accept blood products may require alternative interventions, particularly for complex cardiac surgeries such as a frozen elephant trunk (FET) procedure. We described the case of a patient with an aortic root aneurysm and distal aortic arch pseudoaneurysm for which a FET procedure would be standard management, but instead an alternative course of treatment was chosen as the patient was a Jehovah's witness.
Methods:
We discuss the case of a 46-year-old male Jehovah's witness with a history of congenital aortic coarctation involving the distal transverse arch and descending thoracic aorta. The coarctation was repaired via left thoracotomy when the patient was an infant, however, patient was lost to follow-up until July 2022, at which point an echo showed a dilated root with a bicuspid aortic valve (BAV) and a 5.7 cm aneurysm proximal to the site of the coarctation repair.
Results:
The patient's situation was evaluated, and it was determined that while a FET procedure with a root replacement would be the standard treatment, a staged approach would be better in this scenario as the patient could not accept blood products. The patient's first procedure would repair the pseudoaneurysm and would be followed by an aortic root replacement one month later. For the first procedure, the patient was managed with an endovascular therapy using a GORE-TAG thoracic branched endograft (TBE) with left common carotid artery (LCCA) stent extension of the side portal branch. Access was first established via the left common femoral and left radial arteries, and the GORE-TAG TBE device was then properly positioned and deployed, with good seal proximal and distal in the aorta. No endoleak was noted, and there was no filling of the aneurysm, indicating full exclusion. The patient had an uncomplicated post-operative stay and was discharged on hospital day 3. The patient underwent the subsequent planned bio-Bentall aortic root replacement one month later. Post-op course was notable for atrial fibrillation, but was otherwise uncomplicated, and the patient was discharged on post-op day 8. CTA performed 6 months post-operatively showed stable post-operative thoracic aorta without recurrent aneurysm.
Conclusion:
For patients who are unable to receive blood products alternative management, such as staged surgeries, may be optimal to reduce operative risk. Consideration of patient values is paramount, and developing endovascular technologies allows for new opportunities in complex aortic pathology.
Patients who are unable to accept blood products may require alternative interventions, particularly for complex cardiac surgeries such as a frozen elephant trunk (FET) procedure. We described the case of a patient with an aortic root aneurysm and distal aortic arch pseudoaneurysm for which a FET procedure would be standard management, but instead an alternative course of treatment was chosen as the patient was a Jehovah's witness.
Methods:
We discuss the case of a 46-year-old male Jehovah's witness with a history of congenital aortic coarctation involving the distal transverse arch and descending thoracic aorta. The coarctation was repaired via left thoracotomy when the patient was an infant, however, patient was lost to follow-up until July 2022, at which point an echo showed a dilated root with a bicuspid aortic valve (BAV) and a 5.7 cm aneurysm proximal to the site of the coarctation repair.
Results:
The patient's situation was evaluated, and it was determined that while a FET procedure with a root replacement would be the standard treatment, a staged approach would be better in this scenario as the patient could not accept blood products. The patient's first procedure would repair the pseudoaneurysm and would be followed by an aortic root replacement one month later. For the first procedure, the patient was managed with an endovascular therapy using a GORE-TAG thoracic branched endograft (TBE) with left common carotid artery (LCCA) stent extension of the side portal branch. Access was first established via the left common femoral and left radial arteries, and the GORE-TAG TBE device was then properly positioned and deployed, with good seal proximal and distal in the aorta. No endoleak was noted, and there was no filling of the aneurysm, indicating full exclusion. The patient had an uncomplicated post-operative stay and was discharged on hospital day 3. The patient underwent the subsequent planned bio-Bentall aortic root replacement one month later. Post-op course was notable for atrial fibrillation, but was otherwise uncomplicated, and the patient was discharged on post-op day 8. CTA performed 6 months post-operatively showed stable post-operative thoracic aorta without recurrent aneurysm.
Conclusion:
For patients who are unable to receive blood products alternative management, such as staged surgeries, may be optimal to reduce operative risk. Consideration of patient values is paramount, and developing endovascular technologies allows for new opportunities in complex aortic pathology.
Aortic Symposium:
Aortic Arch
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