Optimizing Postoperative Surveillance Imaging Following Elective Aortic Hemiarch Replacement
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0236
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Nicolas Chanes (1), Zihan Feng (1), Cenea Kemp (1), Austin Gronewold (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
Zihan Feng
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University of Colorado Anschutz
University of Colorado Anschutz
Cenea Kemp
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University of Colorado Anschutz
University of Colorado Anschutz
Austin Gronewold
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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:
The optimal protocol for imaging following aortic hemiarch replacement remains a topic of debate. At our institution, pathology related to the repair typically occurs within the first three months postoperatively. We hypothesize surveillance CT scans performed at 3 months will identify any pathologies requiring re-intervention; additional imaging may be superfluous.
Methods:
Using our single institution-maintained database, 417 patients who underwent an elective aortic hemiarch repair between February of 2010 and December of 2022 were identified. Eight patients (1.9%) who had an in-hospital postoperative mortality were excluded from analysis. For the remaining 409, the stability of post-operative imaging and follow-up with cardiovascular providers was reviewed. Patients requiring re-intervention related to hemiarch replacement were identified, with additional focus on whether pathology was detected during routine post-operative surveillance imaging.
Results:
Of the 409 patients who underwent elective aortic hemiarch repair, 391 (95.4%) completed post-operative follow-up with a cardiovascular provider. A total of 21 patients required operative re-intervention after discharge (5.1%). Of those, 14 patients presented urgently or emergently with symptoms related to their pathology. Only 7 patients (1.7%) had pathology requiring re-intervention found on surveillance imaging. Of those, 4 patients required re-intervention based on their post-hemiarch surveillance imaging, with all pathology detected at three-months. Three patients required re-intervention for surveillance imaging related to other pathology: two patients had distal degeneration of known descending thoracic aortic aneurysms on annual surveillance imaging, and one patient required re-intervention at eight years required to stenosis of their mechanical aortic valve. The Kaplan-Meier survival curve (Figure 1) details duration of follow-up and expected freedom from re-intervention after elective hemiarch replacement.
Conclusions:
This data supports surveillance imaging completed at 3 months following hemiarch replacement is sufficient to identify pathology related to the repair. While other indications may dictate ongoing surveillance, for most patients, the need for further imaging is unnecessary.
The optimal protocol for imaging following aortic hemiarch replacement remains a topic of debate. At our institution, pathology related to the repair typically occurs within the first three months postoperatively. We hypothesize surveillance CT scans performed at 3 months will identify any pathologies requiring re-intervention; additional imaging may be superfluous.
Methods:
Using our single institution-maintained database, 417 patients who underwent an elective aortic hemiarch repair between February of 2010 and December of 2022 were identified. Eight patients (1.9%) who had an in-hospital postoperative mortality were excluded from analysis. For the remaining 409, the stability of post-operative imaging and follow-up with cardiovascular providers was reviewed. Patients requiring re-intervention related to hemiarch replacement were identified, with additional focus on whether pathology was detected during routine post-operative surveillance imaging.
Results:
Of the 409 patients who underwent elective aortic hemiarch repair, 391 (95.4%) completed post-operative follow-up with a cardiovascular provider. A total of 21 patients required operative re-intervention after discharge (5.1%). Of those, 14 patients presented urgently or emergently with symptoms related to their pathology. Only 7 patients (1.7%) had pathology requiring re-intervention found on surveillance imaging. Of those, 4 patients required re-intervention based on their post-hemiarch surveillance imaging, with all pathology detected at three-months. Three patients required re-intervention for surveillance imaging related to other pathology: two patients had distal degeneration of known descending thoracic aortic aneurysms on annual surveillance imaging, and one patient required re-intervention at eight years required to stenosis of their mechanical aortic valve. The Kaplan-Meier survival curve (Figure 1) details duration of follow-up and expected freedom from re-intervention after elective hemiarch replacement.
Conclusions:
This data supports surveillance imaging completed at 3 months following hemiarch replacement is sufficient to identify pathology related to the repair. While other indications may dictate ongoing surveillance, for most patients, the need for further imaging is unnecessary.
Aortic Symposium:
Aortic Arch
Image or Table
