Management and Outcomes of Endocarditis-Related Aortic Root Pseudoaneurysms
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0203
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Elizabeth Devine (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):
Michael Kirsch
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University of Colorado Anschutz
University of Colorado Anschutz
Nicolas Chanes
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University of Colorado Anschutz
University of Colorado Anschutz
Elizabeth Devine
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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:
With progression of infectious endocarditis, destruction of the aortic annulus and root occurs, potentially resulting in aortic root pseudoaneurysms. The standard of care centers around aggressive debridement, reconstruction of any destroyed annulus, and replacement of any infected or necrotic tissue including the valve or root. The vast majority of literature surrounding the topic is related to case reports, and thus, we sought to evaluate our aortic center's institutional outcomes after root replacement for endocarditis-related aortic root pseudoaneurysms.
Methods:
A prospectively maintained institutional database was used to identify patients over the last 10 years who presented with endocarditis-related aortic root pseudoaneurysms. We describe any prior surgical history and temporal relationship to prior surgeries, and subsequent management strategy and outcomes.
Results:
A total of 15 patients with endocarditis-related aortic root pseudoaneurysms were identified. In addition to infectious symptoms, roughly half of the patients presented with additional cardiovascular symptoms, including stroke (2, 13.3%), pericardial effusion (2, 13.3%), and arrhythmia (complete heart block or new onset atrial fibrillation, 3, 20.0%). All but two of the patients had a prior aortic surgical history, except for two patients who presented primarily in the setting of bicuspid aortic valve disease. Most of the cohort had a previous aortic valve replacement (13, 86.7%), with a significant portion having an aortic or valve intervention within the past year (4, 26.7%). All patients underwent concomitant valve and root replacement including mechanical bentall, biobentall or homograft replacement. Roughly a third of patients required concomitant arch intervention of some form, with other adjunctive procedures including coronary artery bypass grafting, mitral valve replacement, and PFO closure. Approximately half of patients (7, 46.7%) were left open for either bleeding or serial washouts, with 2 (13.3%) requiring adjunctive mechanical circulatory support. Post-operatively, rates of coagulopathy were high (7, 46.7%), with a relatively high mortality rate (3, 20.0%).
Conclusions:
For endocarditis-related aortic root pseudoaneurysm to form, patients typically have severe enough progression in their disease that they can present with a number of additional life-threatening pathologies, furthermore, they are subject to increased morbidity and mortality due to their disease progression. Decisive surgical treatment with radical debridement, reconstruction of the annulus, and replacement of the valve and root is of paramount importance.
With progression of infectious endocarditis, destruction of the aortic annulus and root occurs, potentially resulting in aortic root pseudoaneurysms. The standard of care centers around aggressive debridement, reconstruction of any destroyed annulus, and replacement of any infected or necrotic tissue including the valve or root. The vast majority of literature surrounding the topic is related to case reports, and thus, we sought to evaluate our aortic center's institutional outcomes after root replacement for endocarditis-related aortic root pseudoaneurysms.
Methods:
A prospectively maintained institutional database was used to identify patients over the last 10 years who presented with endocarditis-related aortic root pseudoaneurysms. We describe any prior surgical history and temporal relationship to prior surgeries, and subsequent management strategy and outcomes.
Results:
A total of 15 patients with endocarditis-related aortic root pseudoaneurysms were identified. In addition to infectious symptoms, roughly half of the patients presented with additional cardiovascular symptoms, including stroke (2, 13.3%), pericardial effusion (2, 13.3%), and arrhythmia (complete heart block or new onset atrial fibrillation, 3, 20.0%). All but two of the patients had a prior aortic surgical history, except for two patients who presented primarily in the setting of bicuspid aortic valve disease. Most of the cohort had a previous aortic valve replacement (13, 86.7%), with a significant portion having an aortic or valve intervention within the past year (4, 26.7%). All patients underwent concomitant valve and root replacement including mechanical bentall, biobentall or homograft replacement. Roughly a third of patients required concomitant arch intervention of some form, with other adjunctive procedures including coronary artery bypass grafting, mitral valve replacement, and PFO closure. Approximately half of patients (7, 46.7%) were left open for either bleeding or serial washouts, with 2 (13.3%) requiring adjunctive mechanical circulatory support. Post-operatively, rates of coagulopathy were high (7, 46.7%), with a relatively high mortality rate (3, 20.0%).
Conclusions:
For endocarditis-related aortic root pseudoaneurysm to form, patients typically have severe enough progression in their disease that they can present with a number of additional life-threatening pathologies, furthermore, they are subject to increased morbidity and mortality due to their disease progression. Decisive surgical treatment with radical debridement, reconstruction of the annulus, and replacement of the valve and root is of paramount importance.
Aortic Symposium:
Aortic Root
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