Monday, May 4, 2026: 9:00 AM - 4:00 PM
McCormick Place Lakeside Center
Posted Room Name: Exhibit Hall, Poster Area
Track
Adult Cardiac
106th Annual Meeting
Presentations
Authors
Lokeswara Sajja (1), Kunal Sarkar (2), Gopichand Mannam (3), Chandrasekar Padmanabhan (4), Sanjeeth Peter (5), Zile Singh Meharwal (6), Aditya Koppula (7), DHIREN SHAH (8), VENKATA KRISHNA KUMAR KODALI (9), Balakrishna Nagalla (10), Sateesh Sreeramula (7), Lalit Kapoor (11), Chirag Doshi (12), Anvay Mulay (13), Anbarasu Mohanraj (14), Milind Hote (15), Yugal Mishra (16), Vivek Jawali (17), Bashi Velayudhan (18), Pradeep Narayan (11)
Institutions
(1) Star Hospitals, Hyderabad, Hyderabad, Telangana, (2) Medica Superspeciality Hospital, Kolkata, West Bengal, (3) STAR Hospitals, Hyderabad, India, Hyderabad, Telangana, (4) GKNM Hospital, Coimbatore, Tamilnadu, (5) DDMM Heart Institute, Nadiad, Gujarat, (6) Fortis Escorts Heart Institute, New Delhi, India, (7) Sajja Heart Foundation, Hyderabad, Telangana, (8) Care Institute of Medical Sciences (CIMS), Ahmedabad, Gujarat, (9) Krishna Institute of Medical Sciences (KIMS), Hyderabad, Telangana, (10) Apollo Hospitals, Hyderabad, Telangana, (11) Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, (12) U. N. Mehta Institute of Cardiology & Research Centre, Ahmedabad, Gujarat, (13) Reliance Foundation Hospital, Mumbai, Maharashtra, (14) Medway Heart Institute, Chennai, Tamil Nadu, (15) All India Institute of Medical Sciences, New Delhi, India, (16) Manipal Hospitals, New Delhi, India, (17) Fortis Hospitals, Bangalore, Karnataka, (18) SIMS Hospitals, Chennai, Tamil Nadu
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Poster Presenter
*Lokeswara Sajja, Star Hospitals, Hyderabad
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Hyderabad, Andhra Pradesh
India
Authors
Stephan Ensminger (1), Ingo Kutschka (2), Ahmad-Fawad Jebran (2), Christina Paitazoglou (3), Sören Brandenburg (2), Malte Tiburcy (2), Buntaro Fujita (3), Tobias Legler (2), Thomas Puehler (3), Joachim Lotz (2), Monika Sadlonova (2), Tim Friede (2), Wolfram Zimmermann (2)
Institutions
(1) University Heart Center Lübeck, Luebeck, Germany, (2) University Medical Center Göttingen, Göttingen, Germany, (3) University Heart Center Lübeck, Lübeck, Germany
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Poster Presenter
*Stephan Ensminger, Department of Cardiac and Thoracic Vascular Surgery
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Luebeck
Germany
Objective: Ventricular septal rupture (VSR) is a severe complication of acute myocardial infarction, and the conventional technique for repair is associated with high operative mortality. A novel sutureless "double‐patch frame" technique was used as a less invasive treatment for VSR; it does not postpone the timing of surgery, require left or right ventricular incision and suturing in the fragile ventricular wall.
Methods: Four patients underwent successful correction and recovery uneventful. total cardiopulmonary bypass was established via a median sternotomy. A "double‐patch frame" was produced with a trimmed Dacron patch and expandable spongeare just as the data from cardiac CTA and TEE. A low transverse aortotomy and right atriotomy were performed to implant the "double‐patch frame" to correct VSR without suturing. TEE was used to evaluate the residual VSP shunting, biventricular function, and the left ventricular outflow tract.
Results: All procedures were completed safely and effective. The averaged VSR left-to-right shunt before the procedure was 1.55cm (ranged from 1.2cm to 1.8cm). The CPB and aorta clamping time were 139.7min (125-155 mins) and 75min (67-89 mins), respectively. The left-to-right shunt disappeared in one patient after the procedure, and trial residual VSR left-to-right shunt in another three patients without hemodynamic disorder. Hemodynamic instability improved dramatically after the procedure. All the patients had an uneventful postoperative course and discharged successfully. During the following-up, TTE showed the jet is unchanged and all the patients have no symptoms and self-supportive at home
Conclusions: This new sutureless "double‐patch frame" technique was simple and significantly decreased the left-to-right shunt. The technique was able to control the heart failure associated with VSR without ventriculotomies during the procedure. Potential improvements in VSR treatment outcomes are expected with its clinical application.
Authors
Liang Tao (1), Laichun Song (2), Xiao Wang (3)
Institutions
(1) Wuhan Asia heart Hospital, Wuhan, Hubei, (2) Wuhan Asia Heart Hospital, Wuhan, Hubei, (3) Nanjing Drum Tower Hospital, Jiangsu
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Poster Presenter
Liang Tao, Wuhan Asia heart Hospital
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Wuhan, Hubei
China
Objective: Complete revascularization (CR) is a major purpose of coronary artery bypass grafting (CABG). However, an impact of "Anatomical" CR (revascularize all graftable vessels) compared with "Territorial" CR (revascularize at least 1 vessel in each coronary territory) on survival benefit has not been well elucidated.
Methods: This single-center retrospective study included 621 consecutive patients undergoing isolated CABG for three-vessel disease (2011-2017). Territorial CR was defined as at least one bypass graft to each of the three territories (LAD, LCX, and RCA). Anatomical CR was defined as achieved revascularization in all lesions ≥50% stenosis in vessels ≥1.5mm diameter according to SYNTAX trial criteria. Of 621 patients, 443 (71%) achieved anatomical CR (group A), while 178 (29%) underwent territorial CR (group T) with residual lesions in LCX (n=82, 46%), RCA (n=57, 32%), or diagonal branch (n=57, 32%). Nearly all procedures were off-pump (619/621, 99.7%) with bilateral internal thoracic arteries (598/621, 96.3%). Survival analysis used Kaplan-Meier curves and the log-rank test. Multivariate analysis employed Cox proportional hazards regression models, utilizing two approaches: (1) anatomical CR as a binary variable adjusted for key covariates, and (2) a lesion-specific analysis examining residual lesions in individual territories (diagonal branch, LCX, and RCA).
Results: Group T patients were older (69.4±9.6 vs 67.5±9.7 years, P=0.03) and received fewer grafts (4.1±0.8 vs 5.2±1.0, P<0.001). Patients receiving ≥5 grafts: 45/178 (25.3%) vs 342/443 (77.2%), P<0.001. In-hospital mortality was comparable (1/178, 0.6% vs 3/443, 0.7%, P>0.99). At median follow-up of 96 months, 10-year survival was 80.5% (group A) vs 67.9% (group T), P=0.01. Multivariate analysis showed anatomical CR trended toward improved survival (HR 0.68, 95% CI 0.47-1.01, P=0.054). Lesion-specific analysis revealed residual diagonal (HR 1.74, P=0.04) and LCX lesions (HR 1.63, P=0.048) independently predicted mortality, while residual RCA lesions had no impact (HR 0.99, P=0.98).
Conclusions: Anatomical CR demonstrated a strong, clinically relevant trend toward superior long-term survival compared with territorial CR in patients undergoing CABG for complex coronary disease. This benefit is driven by complete revascularization of LAD and LCX territories, as residual lesions in these areas independently predict mortality.
Authors
YOSHINORI NAKAHARA (1), Akira Marui (2), Tomohiro Iwakura (1)
Institutions
(1) Sakakibara Heart Institute, Tokyo, Japan, (2) Kokura Memorial Hospital, Kitakyushu, NA
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Poster Presenter
YOSHINORI NAKAHARA, Sakakibara Heart Institute
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Tokyo
Japan
Objective: Aortic morphology changes and survival outcomes after thoracic endovascular aortic repair for patients with type B aortic intramural hematoma remain unclear.
Methods: Participants were consecutively recruited from an institutional registry for acute aortic syndrome between September 2014 and August 2021. We enrolled patients who underwent TEVAR for type B IMH and evaluated the aortic morphological changes based on follow-up computed tomography angiography and clinical outcomes.
Results: The cohort consists of 292 patients (76.0 % male and 24.0% female) with a median age of 62 (interquartile range: 52-68) years old. During the imaging follow-up of 289 (99%) patients, the majority achieved morphological stability or regression (85.5% of female patients and 82.3% of male patients). Both the maximum descending aortic diameter (decreasing from 35.4 mm to 33.4 mm, P < 0.001) and maximum hematoma thickness (decreasing from 10.2 mm to 3.4 mm, P < 0.001) showed significant reductions. Female patients exhibited a higher incidence of newly developed ascending aortic dissection (5.8%, 4/69) compared to male patients (1.4%, 3/220) (P = 0.04). During clinical follow-up (median: 4.0 years, interquartile range: 2.4-5.8 years), the Kaplan Meier estimated 5-year mortality rates were 17.9% for females and 7.5% for males (P=0.02). In multivariable COX regression analysis, female patients were associated with a higher risk of follow-up death (hazard ratio: 2.43, 95% confidence interval: 1.10-5.35, P = 0.03).
Conclusions: Patients with type B IMH demonstrated significant morphological regression in aortic diameter and hematoma thickness following TEVAR. Additionally, female patients were associated with increased risks of newly developed ascending aortic dissection and higher follow-up mortality compared to their male counterparts.
Authors
Chuan Tian (1)
Institutions
(1) Fuwai Hospital, Beijing, Beijing
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Poster Presenter
Chuan Tian, Fuwai Central China Hospital
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Beijing, Beijing
China
Objective: In VSRR for tricuspid aortic valve (TAV), the three native commissures are typically resuspended equally 120 degrees apart, assuming equal symmetry of the native commissural alignment (CA). Previous studies have shown a frequent need for free margin plication even for patients with no AR. We speculated that this may be due to asymmetric cusps and coaptation mechanism. The study objective is to assess the symmetry of the cusps and coaptation.
Methods: EKG-gated CTAs obtained in diastole phase were analyzed with 3D reconstruction software. A virtual circle was formed by connecting the three commissural peaks. CA was defined as the angle between each commissure and the circle's center. Coaptation point was defined as the junction of the free margins of all three cusps. Of 132 patients with mild or less AR who underwent VSRR for root aneurysm (ANEURYSM), 89 had intraoperative measurements available. CONTROL included 165 patients who underwent screening CTA for calcium scoring. In order to explore how CA corresponds to cusp geometry, correlations between CA and ratios of intraoperative measurements, including free margin length (FML) ratio and geometric height (GH) were analyzed. Each ratio was defined as the smallest cusp divided by the sum of all three cusps.
Results: CA was symmetric (smallest CA of 111 – 120°) in only about half of the patients: 87 patients (52.7%) in CONTROL and 65 patients (49.2%) in ANEURYSM. In ANEURYSM, 2 patients (1.5%) had very asymmetric CA (smallest CA of <100°). CA (degree) had no correlation with the size of sinus (r=-0.11, p=0.016 in CONTROL, r=-0.03, p=0.58 in ANEURYSM). The smallest CA was in left (aneurysm 57.6% vs. control 61.2%), non (34.9% vs. 37.6%), and right (7.6% vs. 1.2%), which was concordant with CT-measured GH and FML in only 57% and 71% of the patients, respectively. The coaptation point did not match with the center of the circle, with a larger deviation in aneurysm group (1.9 ± 1.1mm vs. 1.3 ± 0.6mm in the control group (P<0.001), suggesting an asymmetric coaptation pattern of cusps. Furthermore, degree of smallest CA was not associated with the corresponding ratios of FML or GH measured during VSRR (ratios of FML: r=0.17, p =0.11, GH: r=-0.20, p=0.062).
Conclusions: CA is frequently asymmetric in TAV and may be very asymmetric in aneurysm patients. Cusp coaptation occurs in an asymmetric fashion. CA may not be understood with intraoperative cusp measurement.
Authors
Yuichiro Kitada (1), Nasim Azizgolshani (2), Jack Nickles (3), Marco Tagliafierro (4), Adham Elmously (5), Yanling Zhao (6), Paul Kurlansky, MD (7), Isaac George (8), Andrew Goldstone (2), Hiroo Takayama (2)
Institutions
(1) New York Presbyterian Hospital/Columbia University Irving Medical Center, United States, NY, (2) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (3) N/A, N/A, (4) Columbia Univeristy Irving Medical Center, New York, NY, (5) N/A, New York, NY, (6) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (7) Columbia University Medical Center, Fort Lee, NJ, (8) NYPH-Columbia University Medical Center, New York, NY
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Poster Presenter
Yuichiro Kitada, NewYork- Presbyterian/Columbia University Medical Center
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Fort lee, NJ
United States
Introduction:
The mitral valve is anatomically contiguous with the aortic valve through the aorto-mitral continuity. Excessive anteroposterior annular reduction during mitral valve surgery (MVS) may therefore affect aortic valve function. However, this interaction remains unknown. This study investigated the relationship between the mitral annular anteroposterior reduction rate and postoperative worsening of aortic insufficiency (AI) in MVS.
Methods:
Among 857 patients who underwent MVS between 2010 and 2022, those with concomitant or prior aortic valve surgery, infective endocarditis, or redo MVS (n=374) were excluded. Of the remaining 483 primary MVS cases, 245 patients (50.7%) with preoperative contrast-enhanced CT were analyzed. The mitral annular anteroposterior reduction rate (%) was calculated as: implanted prosthetic ring or valve anteroposterior diameter (mm) / preoperative native mitral annulus anteroposterior diameter (mm) × 100 (lower values indicate greater reduction) (Fig.A). Worsening AI was defined as (1) ≥1 grade increase or (2) unplanned aortic valve surgery for severe intraoperative AI.
Results:
Median age was 67 years [IQR 54–75], 66% were male, and mitral valve repair (MVr) was performed in 202 patients (82.4%), including 159 with full rings and 43 with partial rings. Mitral valve replacement (MVR) was performed in 43 patients (17.6%). Reduction rate was significantly lower in MVr than in MVR (88.2 [82.1–93.4]% vs. 95.2 [89.7–107.0]%, P<0.001; Fig.B). Postoperative worsening of AI occurred in 11.0%, including two patients requiring unplanned aortic valve replacement. In the MVR cohort, reduction rates did not differ between patients with and without worsening AI (97.8 [89.9–103.0]% vs. 94.5 [89.0–117.0]%, P>0.999; Fig.C). In the MVr cohort, reduction rates tended to be lower in patients with worsening AI (85.2 [75.4–92.2]% vs. 88.9 [82.8–93.8]%, P=0.077). In the partial ring subgroup, reduction rates were comparable (93.8 [90.1–97.1]% vs. 89.4 [83.2–96.4]%, P=0.259; Fig.D), whereas, in the full ring subgroup, worsening AI was associated with significantly lower reduction rates (81.6 [74.0–87.8]% vs. 88.1 [82.3–93.7]%, P=0.009; Fig.E).
Conclusions:
In primary MVS, excessive anteroposterior reduction of the mitral annulus, particularly with a full ring, was significantly associated with postoperative worsening of aortic insufficiency. Careful annular sizing is essential to avoid adverse aortic valve interactions.
Authors
Kazuma Handa (1), Shin Yajima (1), Yusuke Yanagino (1), Yumi Kakizawa (1), Daisuke Yoshioka (1), Takuji Kawamura (1), Ai Kawamura (1), Yusuke Misumi (1), Shunsuke Saito (1), Shigeru Miyagawa (1)
Institutions
(1) Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan
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Poster Presenter
Kazuma Handa
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Suita
Japan
Objective: Two ongoing trials comparing transcatheter edge-to-edge repair (TEER) to surgical mitral repair (MVr) for primary mitral regurgitation (MR) include intermediate surgical risk patients, but results are still years away. Nevertheless, TEER use has recently increased in intermediate risk patients without evidence. This study aims to assess outcomes of MVr and TEER in patients with severe primary mitral regurgitation who are at least intermediate risk.
Methods: All patients with severe primary MR undergoing MVr or TEER with intermediate or higher surgical risk (STS PROM ≥ 2% or age ≥ 75) between 2014 and 2025 at a single quaternary institution were included. Patients with severe mitral annular calcification, prior mitral surgery, a ventricular assist device, dialysis dependence or severe tricuspid regurgitation (TR) were excluded. Concomitant operations included CABG, left atrial appendage exclusion, Maze and tricuspid repair (for less than severe TR). Primary outcomes were observed versus expected (O:E) mortality.
Results: A total of 343 patients (mean age=78 ±7 years) underwent MVr (n=295) or TEER (n=48). MVr patients were younger, had fewer previous MI and stroke, but had similar frequency of heart failure. MVr patients had lower STS PROM (3.2% ± 0.3 vs. 6.8% ± 1.0, p< 0.001). Operative mortality was 3.1% (9/295, O:E=0.97) in the MVr group and 2.1% in the TEER (1/48, O:E=0.31, p<0.001) group. There was no difference in discharge location between groups, p=0.36.
Post-repair transesophageal echocardiography (TEE) demonstrated a greater proportion of mild or less residual MR following MVr compared to TEER (99.7% [294/295] vs. 37.4% [19/48], p<0.001). The post-repair mean mitral gradient was 2.8±1.3 and was lower in the MVr group (2.7±1.3 vs 3.3±1.4, p=0.017). On most recent echocardiography, 68.5% (202/295) of MVr patients had mild or less regurgitation versus 27.1% (13/48) for TEER patients (p<0.001). At a mean 1.9 years of follow-up, MVr patients were less likely to require repeat mitral intervention (1.4% [4/295] vs. 10.4% [5/48], p<0.001).
Conclusions: Surgical mortality for intermediate risk patients is consistent with STS PROM, but lower than predicted for TEER. Early and late post procedural outcomes for surgical repair are favorable with minimal residual MR and rare reintervention at nearly two years. Ongoing clinical trial results will weigh the balance between surgery and TEER of higher procedural risk with better durability.
Authors
Sanjhai Ramdeen (1), Shawn Reginauld (1), Dani Ahmetovic (1), Gurnoordeep Pawar (1), Ricky Patil (1), Carol Ling (1), Jeremy Wolverton (1), China Green (1), Matthew Romano (1), Steven Bolling (1), Robert Hawkins (2), Gorav Ailawadi (1)
Institutions
(1) University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, (2) University of Michigan, Department of Cardiac Surgery, Ann Arbor, MI
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Poster Presenter
Sanjhai Ramdeen, Michigan Medicine - University of Michigan
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Ann Arbor, MI
United States
Objective: Current risk-adjustment models in cardiac surgery are geographically blind, treating community-level risks as a uniform national average. We hypothesized that the impact of social deprivation and air pollution on CABG mortality is not constant, but clusters into distinct, geographically-specific regimes.
Methods: Using public Centers for Medicare & Medicaid Services (CMS), Census, and Environmental Protection Agency (EPA) data, we identified a 2023 cohort of 850 US hospitals performing CABG. We defined granular, patient-flow-derived Hospital Service Areas (HSAs) for each. We calculated a population-weighted Area Deprivation Index (ADI) and Particulate Matter (PM2.5) pollution exposure for each HSA. Geographically Weighted Regression (GWR) was used to model the local association between risk-adjusted 30-day CABG mortality and these community factors, controlling for hospital ownership.
Results: A standard ordinary least squares (OLS) model confirmed that higher ADI was a significant predictor of increased mortality nationally (coefficient: +0.0089, p<0.001). However, GWR revealed that the magnitude of this harm follows a bimodal distribution. A "Compounded Risk" regime, with a strong link between deprivation and mortality, was identified in hospitals clustered in the Great Plains. In contrast, a "Mitigated Risk" regime with a much weaker association was found in other regions, including the Pacific Northwest. The relationship with PM2.5 was trimodal, unmasking a "Delta Paradox" of confounding in the Deep South and, most critically, a distinct environmental "hot spot" where higher PM2.5 was associated with a significant increase in mortality, clustered along the Southeastern Atlantic Seaboard.
Conclusions: The impact of community determinants on CABG outcomes is not a simple continuum but a set of distinct, geographically coherent regimes. Geographically blind risk models are insufficient, as they fail to capture critical, place-based drivers of surgical outcomes. Health policy aimed at improving surgical quality must be tailored to the unique social and environmental realities of the communities that hospitals serve.
Authors
Alyster Alcudia (1), Glade Adams (1), Aryan Gupta (1), Priya Joshi (1), Kristina Lowndes (1), Subodha Kumar (2), William Moser (3), Suyog Mokashi (3)
Institutions
(1) Lewis Katz School of Medicine at Temple University, Philadelphia, PA, (2) Fox School of Business at Temple University, Philadelphia, PA, (3) Temple University Hospital, Philadelphia, PA
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Poster Presenter
Priya Joshi, Lewis Katz School of Medicine at Temple University
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Philadelphia, GA
United States
Objective: Currently available materials for heart valve repair and replacement are prone to structural degeneration and calcification. We aim to develop a novel, durable biomaterial using biostable polymers that mimics the tri-layer microarchitecture of native valve tissue for optimal hydrodynamic function.
Methods: Valved conduits (23 mm diameter) were made using polycarbourethane (PCU) and expanded polytetrafluorethylene (ePTFE) based leaflet materials (n=18, 3 of each material configuration). The valved conduits were fabricated using a novel suture-less technique in which the leaflets were cut from the desired materials and loaded into a mandrel, and a PCU film conduit was then dip coated around the leaflets. The leaflet materials used were lyophilized PCU foam, plate-casted PCU film, PCU film/foam/film (FFF) to recapitulate the tri-layer microarchitecture of native leaflet tissue, and ePTFE from three different industrial manufacturers (W. L. Gore and Associates, International Polymer Engineering (IPE), Zeus Scientific). The resulting valved conduits were tested on a pulse duplicator (HDTi-6000, BDC Laboratories) under aortic and pulmonary conditions to ascertain their hydrodynamic properties, including regurgitation fraction (RF), effective orifice area (EOA), and mean positive pressure difference (PPD). Hydrodynamic properties were compared using the t test and linear regression.
Results: The hydrodynamic properties for each valve leaflet material are shown in Figure B. Under aortic conditions, the PCU FFF valves had lower PPD than the ePTFE-based valves (p=0.01). PCU film valves had a lower RF than with the Zeus ePTFE valves (p<0.01) and the Gore ePTFE valves (p<0.01). Linear regression showed a higher EOA (p=0.04) and lower PPD (p=0.05) for thinner leaflets in PCU-based valves and a lower RF for thinner leaflets in ePTFE-based valves (p<0.01). For all valves tested under pulmonary conditions compared with aortic conditions, the EOA was lower (p<0.01) and the PPD was lower (p<0.01).
Conclusions: A tri-layer PCU-based valve compares favorably with ePTFE-based valves with a lower PPD and no significant difference in other hydrodynamic properties. Changes in hydrodynamic properties due to thickness vary based on leaflet material. The same valves tested under pulmonary conditions had lower EOA and PPD compared with aortic conditions.
Authors
V. Reed LaSala (1), Mingze Sun (1), Senay Ustunel (1), Elizabeth Cordoves (1), Kavya Rajesh (1), Sophia Jackman (1), Halil Beqaj (1), David Kalfa (1)
Institutions
(1) Nicklaus Children’s Hospital, Miami, FL
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Poster Presenter
V. Reed LaSala, NYPH-Columbia University Medical Center
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New York, NY
United States
Objective: Although the recommended target INR for anticoagulation therapy after mitral valve replacement (MVR) does not vary by race, current guidelines are largely based on studies conducted in Western population. However, studies have suggested that the optimal level of anticoagulation may differ between Asian and Western populations. This study aimed to compare long-term outcomes after mechanical MVR between Asian and Western populations.
Methods: From 2000 to 2020, 980 consecutive patients undergoing mechanical MVR were enrolled at two tertiary centers located in Asia and West, respectively. Propensity scores were calculated using 22 preoperative and operative variables, and 1:1 propensity score matching was performed to compare outcome between Asian group (n=508) and Western group (n=472). Bleeding events were defined according to the VARC-3 criteria, and type 2 or higher was classified as major bleeding. The composite outcome of thromboembolic and bleeding events included major bleeding (type 2 or higher) and thromboembolic events.
Results: Before matching, significant differences were observed in baseline characteristics such as age, hypertension and overweight and atrial fibrillation between Asian and Western groups. Overall, the Aian population demonstrated significantly better long-term survival, and lower incidences of thromboembolic events, any bleeding and the composite outcome of bleeding and thromboembolic events. After matching, 141 well-balanced pairs were obtained. In the matched cohort, overall survival remained significantly better in the Asian group (P < 0.001). While there was no significant difference in any bleeding events between the groups (P = 0.231), major bleeding occurred significantly more frequently in the Western group (P = 0.028). Thromboembolic events and the composite outcome of major bleeding and thromboembolic events were also significantly more frequent in the Western group (P = 0.002 and P = 0.013, respectively).
Conclusions: After mechanical MVR, Asian patients demonstrated superior long-term survival and a lower incidence of anticoagulation-related complications, including bleeding and thromboembolic events, compared with Western patients. These findings suggest that population-based differences should be considered when determining prosthetic valve type, and highlight the need for further research to define optimal anticoagulation targets tailored to Asian populations.
Authors
Jae Woong Choi (1), Yoonjin Kang (1), Suk Ho Sohn (1), Ho Young Hwang (1), Kyung Hwan Kim (1), Jeffrey Gaca (2), Brittany Zwischenberger (2), Carmelo Milano (2), Keith Carr (2), Donald Glower (2)
Institutions
(1) Seoul National University Hospital, Seoul, South Korea, (2) Duke University Medical Center, Durham, NC
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Poster Presenter
Jae Woong Choi, Seoul National University Hospital
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Seoul
South Korea
Objective
Non-invasive rejection monitoring using HeartCare, a combination of gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cf-DNA), has proven useful as an alternative to post-transplant biopsy. However, limited accessibility prevents its standard application. Conversely, complete blood cell ratios (CBRs) are derived from routine CBC differentials (CBCD) and have demonstrated capabilities in predicting heart transplant rejection. This study aimed to evaluate the relationship between HeartCare and myocardial biopsy results with components of a routine CBCD.
Methods
We enrolled 33 of 34 patients (female n=9; 32±17 years old; 12.2 tests/patient) registered in the SHORE (Surveillance HeartCare Outcomes) Registry who received regular HeartCare follow-up and had a negative prospective crossmatch. The relationship between five immediate pre-test CBCD components (neutrophil, lymphocyte, monocyte, neutrophil-lymphocyte ratio [NLR], and lymphocyte-monocyte ratio [LMR]) and HeartCare positivity (defined as GEP ≥34 and dd-cf-DNA ≥0.2) was analyzed across 407 tests using a Linear Mixed-Effect Model. The cut-off value of the resulting variable was then validated against mild or greater rejection using a generalized linear mixed model, incorporating 373 post-transplant myocardial biopsy results from the same patients.
Results
The study population consisted of 29 White, 1 Black, 2 Asian, and 1 other patient. Heart transplant status at transplantation was status 1 (1), status 2 (8), status 3 (11), status 4 (9), and status 6 (4). HeartCare positivity was observed in 46 tests. LMR showed the strongest association with HeartCare positivity (p=0.006, R²=0.45), followed by lymphocyte (p=0.002, R²=0.40) and NLR (p=0.03, R²=0.26). The cut-off for LMR to prompt consideration of HeartCare was calculated from the ROC curve. An LMR of 2.00 yielded a sensitivity of 91% and specificity of 63%. These 33 patients underwent 373 biopsies including 88, 5, and 2 patients with grade 1, 2, and 3 cellular rejection, respectively. An LMR cut-off of 2.0 was significantly associated with higher odds of mild or greater cellular rejection (OR 2.32 [1.33-4.00], p=0.003).
Conclusion
These results demonstrate a novel application of LMR as a highly accessible biomarker strongly associated with combined GEP and dd-cf-DNA rejection monitoring and myocardial biopsy results. LMR may aid in guiding decisions regarding HeartCare testing, biopsy, and immunosuppression treatment.
Authors
Isaac Knouff (1), Tomoki Sakata (2), Maika Schneider (3), Ioannis Dimarakis (1), richard cheng (2), April Stempien-Otero (2), Jay Pal (2)
Institutions
(1) University of Washington School of Medicine, Seattle, WA, (2) University of Washington Medical Center, Seattle, WA, (3) University of Washington, Seattle, WA
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Poster Presenter
Isaac Knouff, University of Washington School of Medicine
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Olympia, WA
United States
Objective: Myxomatous (degenerative) mitral valve (MV) disease is the leading cause of mitral regurgitation (MR) in Western countries and represents a significant global health burden. With the rise of transcatheter therapies, real-world data on surgical management including repair rates, outcomes, and center-level practices are increasingly needed.
Methods: From MITRACURE, a multicenter registry of 40 centers across Canada and France of consecutive adult patients who underwent surgery for MR in 2019, we selected the subset of patients with myxomatous MR.
Results: MV surgery was performed in 2,135 patients with myxomatous MR (70% male, 65±12 years). Thirty-seven percent were in NYHA III/IV, only 17% were considered asymptomatic, and early intervention was performed in 4%. MV repair was achieved in 80% of patients, with a 6% intraoperative repair failure rate. In-hospital mortality was 2.3%, significantly lower after repair (1.4%) than replacement (6.2%, P<0.0001). Major complications occurred in 20%, with higher rates in replacement and combined procedures (Figure 1). Independent predictors of mortality included NYHA III/IV, type of surgery, and EuroSCORE II. Repair rates declined with age, comorbidities, and complex anatomy, and increased with center volume (68%, 77%, and 84% in low, intermediate, and high-volume centers, respectively; P<0.0001). Sex was not independently associated with repair rates after adjustment.
Conclusions: In this large real-world cohort from two publicly funded healthcare systems, many patients with myxomatous MR were referred late for surgery, and early intervention remained rare. While in-hospital mortality was low overall, outcomes varied across subgroups. MV repair was achieved in the majority of cases but declined with age and MV anatomical complexity. High-volume centers had better outcomes, supporting earlier referral, structured pathways, and surgical centralization to optimize care.
Authors
Denis Bouchard (1), Julien Dreyfus (2), Thierry Letourneau (3), Julien Ternacle (4), Michel Pellerin (5), Bernard Iung (6), William Kent (7), Jean-Francois Obadia (8), Michael Chu (9), David Messika-Zeitoun (10)
Institutions
(1) Montreal Heart Institute, Outremont, QC, (2) Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France, St-Denis, France, (3) CHU Nantes, Nantes, France, (4) CHU de Bordeaux, Bordeaux, France, (5) Montreal Heart Institute, Montreal, QC, (6) Hôpital Bichat, Paris, France, (7) N/A, N/A, (8) Louis Pradel, LYON-Bron, Rhône-Alpes, (9) University of Western Ontario, London, ON, (10) University of Ottawa Heart Institute, Ottawa, Ontario
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Poster Presenter
*Denis Bouchard, Montreal Heart Institute
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Outremont, QC
Canada
Objective: The 2020 ACC/AHA guidelines on valvular heart disease resulted in class 1A recommendations for surgical aortic valve replacement (SAVR) for patients with aortic stenosis under 65 or with life expectancy over 20 years. Despite this, transcatheter aortic valve replacement (TAVR) use continues to rise. Limited data exist on what factors influence the use of TAVR over SAVR in this younger population. We examined national trends, predictors, and utilization of TAVR versus SAVR among patients under 65.
Methods: The National Inpatient Sample (2016–2022) was queried for patients aged 20 to 65 undergoing TAVR or SAVR for primary diagnosis of aortic stenosis. Descriptive statistics were used to compare cohort demographics (age, sex, race, location, income, and payer status); hospital characteristics (control, teaching status, region, and bed size); comorbidity index; and utilization (total cost and length of stay) . Multivariable logistic regression identified independent predictors of TAVR or SAVR, adjusting for demographics, hospital characteristics, and comorbidities.
Results: A weighted total of 74,720 patients underwent TAVR or SAVR, with 52,145 (69.8%) receiving SAVR. TAVR volume rose from 1,330 procedures in 2016 to 4,420 in 2022 (+232% increase), while SAVR declined from 9,120 to 6,720 (−26% decrease). Compared to TAVR, SAVR patients were younger (median 55 [IQR 50–60] vs. 62 [59–64] years, P<0.001) and more likely male (68.4% vs. 61.5%, P<0.001). SAVR was less commonly performed at urban teaching (86.3% vs. 89.6%, P<0.001) and large hospitals (66.6% vs. 72.5%, P<0.001). No regional differences were observed. Despite longer median length of stay in SAVR patients (5 [IQR 4–7] vs. 2 [1–3] days, P<0.001), costs were similar ($45,737 [36,217–59,668] vs. $44,217 [34,524–58,342], P=0.265). On multivariable analysis, TAVR was independently associated with older age, female sex, Black race, larger hospitals, urban teaching centers, higher comorbidity index, and later year of procedure. SAVR was associated with private insurance, Hispanic or Asian/Pacific Islander race, and rural hospitals.
Conclusions: Among patients under 65, TAVR utilization is increasing while SAVR is declining. While SAVR is associated with longer hospitalization, total costs are comparable. Utilization may be influenced by sociodemographic and hospital factors. Greater adherence to clinical guidelines may reduce national variability and disparities in treatment.
Authors
Sean Nguyen (1), Koray Potel (1), Emma Schaffer (2), Brett Norling (1), Rochus Voeller (3), Stephen Huddleston (4), Andrew Shaffer (2), Rosemary Kelly (1), Ranjit John (2)
Institutions
(1) University of Minnesota, Minneapolis, MN, (2) University of Minnesota Medical Center, Minneapolis, MN, (3) University of Minnesota Medical School, Minneapolis, MN, (4) University of Minnesota Medical School, Saint Paul, MN
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Poster Presenter
Sean Nguyen, University of Minnesota
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Minneapolis, MN
United States
Objective: We sought to describe the incidence, postoperative outcomes, and rate of recovery in CABG patients who develop postoperative diaphragm dysfunction (DD).
Methods: Patients at a single institution who underwent CABG between July 2015 and May 2025 were included. Diagnosis of DD was based on diaphragm elevation on routine postoperative chest X-ray and confirmation via ultrasound (Sniff test). Postoperative outcomes were compared between patients with and without DD using inverse probability of treatment weighting (IPTW). Patients were followed with diaphragm imaging at 3-month intervals until recovery or 2 years.
Results: The incidence of postoperative DD after CABG was 3.1% (111/3594), with 60 left sided DD, 50 right sided DD, and 1 patient with bilateral DD. Preoperative characteristics were similar between those with and without DD, however, patients with DD had higher rate of chronic lung disease (31.5% [35/111] vs 19.9% [692/3483], p=0.004) and more bilateral IMA utilization (48.6% [54/111] vs 38.4% [1339/3483], p=0.04). Among patients who underwent left IMA harvest (including BIMA), the incidence of left sided DD was 1.7% (60/3477) and for isolated left IMA harvest, right sided DD incidence was 0.3% (7/2084). Among patients undergoing right IMA harvest (including BIMA), the incidence of isolated R DD was 2.9% (43/1469). After IPTW weighting, patients with DD had longer length of stay (10.7 ± 9.4 vs 8.7 ± 8.1 days; p=0.03), increased rates of postoperative pneumonias (5.7% vs 2.3%, p=0.02), reintubation (7.4% vs 2.1%, p=0.001), ICU readmission (5.0% vs 1.9%, p=0.04), and postoperative cardiac arrest (3.8% vs 1.1%, p=0.03). Early mortality was similar between groups (p=0.52). Among patients with DD, 79.3% (88/111) had follow up diaphragm imaging beyond 60 days from surgery. Of patients with left DD, 45% (27/60) demonstrated recovery after a median of 7.5 months (IQR 3.1-18.9), while 38% (19/50) of patients with right DD demonstrated recovery after a median of 3.6 months (IQR 3.1-33). Median follow-up time for patients without recovery was 13.0 months (IQR 4.1-44.4).
Conclusions: While the overall rate of diaphragm dysfunction after CABG surgery is low, it is associated with increased postoperative morbidity. IMA harvest is a risk factor for DD, however the laterality of harvest is not the only factor involved, and further investigation into other causes of diaphragm dysfunction after CABG is necessary.
Authors
William Mitchell (1), Sameer Singh (1), Alice Vinogradsky (1), Darina Kirilina (1), Marco Tagliafierro (1), Paul Kurlansky, MD (1), Koji Takeda (1), Craig Smith (1), Syed Raza (1)
Institutions
(1) NewYork- Presbyterian/Columbia University Medical Center, New York, NY
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Poster Presenter
William Mitchell, NewYork- Presbyterian/Columbia University Medical Center
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River Edge, NJ
United States
Objective: This study compares outcomes of valve-sparing root replacement (VSRR) with and without aortic valve (AV) leaflet plication for repair of aortic insufficiency (AI).
Methods: A retrospective analysis was conducted on 575 patients who underwent VSRR, of whom 77 (13.4%) had VSRR with concomitant AV leaflet plication (VSRR+AVr), while 498 (86.6%) underwent isolated VSRR. The primary outcomes were 10-year freedom from recurrent AI and AV reintervention. Factors associated with moderate or severe AI or AV reintervention were identified using multivariable regression analysis.
Results: The mean age of the cohort was 49.6±14.1 years, with no significant difference between groups (49.5±14.2 vs. 49.7±14.1, p=0.948). Patients in the VSRR+AVr group had a higher incidence of bicuspid AV (64.9% vs. 17.3%, p<0.001) and more preoperative severe AI (68.8% vs. 26.1%, p<0.001). At the end of the operation, no patients had more than mild residual AI, with no significant difference in the rates of mild residual AI between groups (1.3% vs. 2.8%, p=0.696). Perioperative complications were similar between groups (Table). At 10 years, freedom from moderate or severe AI was 87% in the VSRR+AVr group and 89.4% in the isolated VSRR group [HR 0.98 (0.71-1.35), p=0.905]. Leaflet plication was also not associated with a significantly higher risk of AV reintervention [HR 0.86 (0.67-1.1), p=0.232] (Figure).
Conclusion: VSRR with leaflet plication for AI repair does not increase operative mortality or the risk of long-term AI recurrence compared to isolated VSRR. While leaflet plication was predominantly performed in patients with bicuspid valves, the long-term valve function outcomes were comparable. This technique appears safe for patients requiring AI repair in the context of VSRR.
Authors
Eilon Ram (1), Christopher Lau (1), Alexander Gregg (2) (,3), Michael Rogers (4), N. Bryce Robinson (5), Charles Mack (6), Leonard Girardi (7)
Institutions
(1) Weill Cornell Medicine, New York, NY, (2) NYP, New York, NY, (3) Weill Cornell Medicine, N/A, (4) University of South Florida, Tampa, FL, (5) New York Presbyterian, New York, NY, (6) Weill Cornell Medical College, Cornell University, Manhasset, NY, (7) Weill Cornell Medical Center, New York, NY
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Poster Presenter
Eilon Ram, Weill Cornell Medicine
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New York, NY
United States
Objective:
The American College of Cardiology and American Heart Association guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following CABG performed after acute coronary syndrome (ACS). However, the role of DAPT remains unclear in patients with heart failure with reduced ejection fraction (HFrEF) undergoing elective CABG. We investigated short- and mid-term outcomes of aspirin (ASA) monotherapy versus DAPT following elective CABG in patients with HFrEF.
Methods:
Using the TriNetX research network, we retrospectively analyzed electronic health records from 71 healthcare organizations in the United States. Adults with HFrEF undergoing elective CABG at least one month after ACS were assigned to ASA monotherapy (n= 5,629) or ASA + clopidogrel (n = 11,329). Propensity score matching yielded 5,495 patients per group. Outcomes included all-cause mortality, stroke, myocardial infarction (MI), atrial fibrillation (AF), revascularization, and bleeding at 90 days and 1-year post-CABG.
Results:
At 90 days, patients on DAPT experienced a lower risk of mortality compared to ASA alone (4.7% vs 6.7%, risk ratio [RR] 0.701, 95% CI 0.600-0.819, p <0.001). Risk of MI and revascularization was higher in the DAPT group while the ASA group had non-significant, lower rates of bleeding, AF, and stroke. At 1 year, mortality remained lower in the DAPT group (7.7% vs 9.8%, RR 0.787, 95% CI 0.713 – 0.855, p < 0.001). Similar non-significant trends in bleeding, AF, and stroke were observed at 1 year vs 90 days.
Conclusion:
DAPT using clopidogrel and ASA after elective CABG in patients with HFrEF is associated with a reduction in 90-day and 1-year mortality when compared to ASA monotherapy, despite an increase in bleeding risk. However, other major ischemic events, such as stroke, MI, and revascularization, were higher in DAPT than ASA alone. These findings support that DAPT may reduce all-cause mortality despite a higher risk of ischemic events, suggesting a reduction of severity in thrombotic events or stabilization of high-risk plaques. These findings may inform new post-CABG antiplatelet strategies in patients with HFrEF, but further studies are needed to clarify this net clinical benefit and guide evidence-based recommendations.
Authors
Chris Hsu (1), Sudhanvan Iyer (1), Ali Shirafkan (1)
Institutions
(1) University of Texas Medical Branch, Galveston, TX
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Poster Presenter
Chris Hsu, UTMB-Galveston
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Galveston, TX
United States
Objective: As the number of patients with prior mediastinal radiation continues to rise, managing radiation-associated coronary artery disease has become an increasingly common and timely challenge. Given concerns about late radiation effects on arterial conduit patency, the optimal graft choice for CABG remains uncertain. This study evaluated the durability of internal mammary artery (IMA) grafts and long-term outcomes in this high-risk population.
Methods: We retrospectively identified all patients who underwent isolated CABG at Mass General Brigham with a history of mediastinal radiation. A 1:3 propensity score–matched cohort without prior mediastinal radiation was constructed based on demographics, comorbidities, and operative characteristics. IMA graft patency was assessed among patients who underwent postoperative coronary angiography, and long-term survival was evaluated using Kaplan–Meier analysis.
Results: A total of 141 patients with prior mediastinal radiation were matched to 423 controls, with balanced baseline characteristics (standardized mean differences <0.1 for all covariates). IMA utilization was lower in the mediastinal radiation group compared with controls (93.3% vs 97.6%, p=0.017), most commonly due to prior radiation or previous cardiac surgery. Radial artery and venous conduit use did not differ significantly between groups. Follow-up coronary angiography was performed more frequently among patients with prior radiation (21.4% vs 12.0%,p = 0.006). Among those who underwent angiography, IMA graft patency (<50% stenosis) was lower in the radiation group (63.3% vs 80.0%) but did not reach statistical significance (p = 0.331). Complete occlusion occurred more often in the radiation cohort (26.7% vs 14.0%). Long-term survival was significantly reduced in the radiation group, with mortality rates of 9.2% vs 3.8% at 1 year (p=0.0113) and 25.5% vs 16.6% at 10 years (p=0.0180). Kaplan–Meier analysis demonstrated inferior overall survival among radiation-exposed patients (HR=1.69, 95% CI 1.14–2.49,p=0.0088).
Conclusion: In this dual-center propensity-matched analysis, prior mediastinal radiation was associated with lower IMA utilization, a trend toward reduced graft patency, and worse long-term survival. Although angiographic follow-up was symptom-driven, these findings raise important questions about the long-term durability of IMA grafts. Practitioners might consider alternative conduit strategies in patients with a history of radiation.
Authors
Adham Makarem (1), Emmanuel Odekunle (2), Patrick Udeh (1), Zoe Laddis (1), Carly Liquori (1), Jack Guiry (3), Boateng Kubi (4), Niyi Odewade (5), Jordan Bloom (1), Motahar Hosseini (1), Arminder Jassar (1), Antonia Kreso (6), Nathaniel Langer (7), Serguei Melnitchouk (1), Eriberto Michel (1), Alireza Rabi (1), David D'Alessandro (8), Sary Aranki (9), George Tolis (10), Ashraf Sabe (11), Thoralf Sundt (12), Akinobu Itoh (10), Asishana Osho (1)
Institutions
(1) Massachusetts General Hospital, Boston, MA, (2) N/A, N/A, (3) Massachusetts General Hospital, Charlottesville, VA, (4) Massachusetts General Hospital, Everett, MA, (5) Brigham & Women's Hospital, Brighton, MA, (6) Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, (7) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (8) Harvard University Medical School, Weston, MA, (9) N/A, Boston, MA, (10) Brigham and Women's Hospital, Boston, MA, (11) Brigham and women's hospital, Boston, MA, (12) Harvard University, Boston, MA
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Poster Presenter
Adham Makarem, Massachusetts General Hospital
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Boston, MA
United States
Objectives:
Endoscopic beating-heart tricuspid valve (TV) surgery is increasingly used in cardiac surgery due to improved postoperative outcomes. Traditional approaches require jugular vein cannulation and total CPB with bicaval cannulation. Caval snaring is always required during beating heart TV surgery to avoid air lock. We present our single-center experience using a percutaneously placed novel venous cannula (Smart Canula), allowing minimal invasive TV surgery without additional jugular cannulation and/or caval snaring.The cannula resembles a stent and has multiple penetrations (Figure 1), making air lock a rare occurrence.
Methods:
Thirteen patients underwent beating-heart TV surgery. Preoperative AF was present in 10 patients (six paroxysmal, two persistent, two permanent). Eight patients (mean age 72 ± 10 years; 6 female gender) received a 680 mm cannula, and five (mean age 64 ± 8 years; 2 female gender) a 720 mm cannula. Three patients underwent isolated tricuspid procedures; the remainder had concomitant procedures, including mitral reconstruction in 69 %, cryoablation in 62 %, LAA exclusion in 46 %, and single cases of ASD closure. Three patients underwent redo surgeries after previous cardiac procedures. Mean procedure time was 305 ± 153 min, mean aortic cross-clamp 56 ± 37 min. Tricuspid repair using the clover technique was performed in four patients.
Results:
All procedures were completed without intraoperative air lock. Complications included one re-exploration for bleeding and one intraoperative conversion to sternotomy. Median ICU stay was 5 days, mean hospital stay 17 ± 5 days. Pacemaker implantation was necessary in two patients. Postoperative echocardiography at discharge showed tricuspid valve regurgitation Grade 0 in 45 %, Grade I in 45 %, and Grade II in 18 %. In-hospital mortality was 0 %.
Conclusion:
Endoscopic beating-heart tricuspid repair can be safely performed using a novel percutaneous cannula, eliminating the need for jugular cannulation and/or total CPB with bicaval snaring. No air lock or cannula related complications was observed.
Authors
Diyar Saeed (1), Orestis Mallis Kyriakides (2), Feras Kabbesh (2), hamid Naraghi (2), Mohamed Zeriouh (2), Andreas Däuwel (2), Bujar Maxhera (2), Diyar Saeed (2)
Institutions
(1) Heinrich-Heine University Dusseldorf, Krefeld, Germany, (2) Health and Medical University Krefeld, Krefeld, Germany
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Poster Presenter
*Diyar Saeed, Heinrich-Heine University Dusseldorf
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Dusseldorf
Germany
Objective
Success of cardiac transplant is limited by ischemia reperfusion injury (IRI) and resultant primary graft dysfunction (PGD). Ex vivo heart perfusion (EVHP) is a novel preservation strategy that may enable the delivery of targeted therapies to the donor allograft during preservation. Further, our group has adopted EVHP to identifty mitochondrial viability and function as a principal determinant of post-transplant graft function. Cyclosporine (CsA) has been successfully adopted in transplantation as a calcineurin inhibitor for immunosuppression with more recent investigations promoting its efficacy as an inhibitor of the mitochondrial permeability transition pore (mPTP). mPTP opening is a critical step in IRI leading to mitochondrial dysfunction, rupture, and ultimately cellular apoptosis. Herein, we test the hypothesis that EVHP with CsA will improve post-transplantation graft function in a heterotopic transplant model.
Methods
Wild-type C57BL/6 murine hearts were explanted and stratified by 90-minute preservation method: EVHP with acellular, krebs-henseleit (KH) buffer (Group 1) and EVHP with KH buffer + 100 ng/ml CsA (Group 2). Hearts were heterotopically transplanted onto the cervical vessels of recipient mice for 120-minutes of reperfusion prior to assessment of left ventricular function by echocardiography and IRI by immunohistochemistry staining for the macrophage marker f4/80.
Results
Following heterotopic transplantation, Group 2 hearts demonstrated higher levels of fractional shortening (21.71% ± 8.76%, 1.60/2.01 mm vs. 10.04% ± 4.67%, 1.90/2.09 mm, p=0.015) compared to group 1 hearts (Figure 1a). Further, Group 2 hearts were found to have lower numbers of macrophages (32.86 ± 5.98 f4/80 + cell/hpf vs. 43.38 ± 7.56 f4/80 + cell/hpf, p=0.016) compared to group 1 hearts (Figure 1b). Together these findings demonstrate improved graft function and decreased IRI afforded by EVHP with CsA compared to hypothermic, acellular buffer alone, further validating the importance of mitochondrial function and viability on post-transplantation graft function.
Conclusion
CsA attenuates IRI in transplanted murine hearts as demonstrated by improvements in fractional shortening (myocardial function) and decreased macrophage infiltration. These findings support adoption of CsA within EVHP pre-clinical trials to define the optimal strategy to decrease IRI and improve post-transplantation allograft function.
Authors
Jason Breithaupt (1), Jack Zakrzewski (1), Benjamin Borg (1), Nicolas Drysdale (1), James Jaggers (2), Matthew Stone (2)
Institutions
(1) University of Colorado, Anschutz Medical Center, Aurora, CO, (2) Children's Hospital of Colorado, Aurora, CO
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Poster Presenter
Jason Breithaupt
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Denver, CO
United States
Objective
This study aims to evaluate the potential of FLI as a supplementary tool for intraoperative frozen section analysis in lung cancer and as a method for predicting the efficacy of neoadjuvant therapy in esophageal cancer. The goal is to assess how FLI images can enhance intraoperative decision-making in lung cancer and provide insights into treatment responses in esophageal cancer.
Methods
We collected 73 tissue samples from 40 patients undergoing resection for lung and esophageal cancers. The tissue was imaged using the FLI system, which provides high-resolution, label-free, and multi-modal imaging without the need for staining or sectioning. HE-stained sections were prepared for each sample as the gold standard for pathological comparison. The FLI images and HE sections were analyzed for their ability to detect key tissue structures and tumor regions.
Results
We collected tissue samples from 40 patients undergoing resection for lung and esophageal cancers, including both pre- and post-treatment samples from esophageal cancer patients receiving neoadjuvant therapy. A total of 73 samples were imaged using the FLI system, which enables high-resolution, label-free, multi-modal imaging without the need for staining or slicing. H&E-stained sections were prepared for each sample for comparison. FLI images were analyzed for tumor detection, margin evaluation, and therapy-induced tissue changes in esophageal cancer.
Conclusions
FLI technology holds great promise as a real-time, label-free imaging method that could complement intraoperative frozen section analysis. The findings suggest that FLI may offer enhanced precision in tumor detection and surgical margin evaluation. However, further studies with a larger sample size and continued development of machine learning algorithms are needed to fully realize its potential as a reliable adjunct to traditional pathology techniques.
Authors
Hao Yin (1), Hao Yin (1), Ming Li (1), Fangyi Liu (1), Wendi Zhu (1), Wenlong Yu (2), Xin Zhu (2), Mingxiang Feng (1), Lijie Tan (1)
Institutions
(1) Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, Shanghai, (2) Femtosecond Research Center(Guangzhou), Ltd, Guangdong, Guangzhou
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Poster Presenter
Hao Yin, Zhongshan Hospital, Fudan University
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Shanghai, Shanghai
China
Objective: Because of restricted patient positioning and limited cannulation sites, totally endoscopic robotic mitral valve repair carries a unique risk of cerebral hypoperfusion, particularly in the right upper watershed territory, which lies farthest from the femoral arterial cannula in the left decubitus position. After encountering strokes localized to this "zone of risk," we established a protocol for stroke prevention. This study evaluates the efficacy of our strategy to preserve cerebral perfusion in the right upper hemisphere.
Methods: Between May 2014 and September 2025, 1,578 patients underwent robotic mitral valve repair at our institution. Beginning with the 464th case, the following cerebral-protection protocol was implemented:
1. Right axillary arterial cannulation, not only in patients with aortic atherosclerosis (calcification > 50% of circumference) but also in those with small iliac arteries (diameter < 7 mm);
2. Releasing robotic ports from the chest wall and placing the patient in the Trendelenburg position during cardiopulmonary-bypass weaning or when upper-extremity perfusion pressure fell < 50 mmHg during cardiac arrest;
3. Minimizing cardiopulmonary-bypass duration.
Outcomes before (Group A, n = 463) and after (Group B, n = 1,115) protocol implementation were compared.
Results: Mean age was 54 ± 12 years in Group A and 58 ± 12 years in Group B; females accounted for 33% and 34%, respectively. Right axillary arterial cannulation was performed significantly more frequently in Group B (1.7% vs 29.1%; p < 0.001). Cardiopulmonary-bypass time was shorter in Group B (124 ± 25 vs 99 ± 31 min; p < 0.001). The overall incidence of stroke decreased significantly after protocol implementation (1.7% vs 0.45%; p = 0.026, Fisher's exact test; odds ratio [Group B vs A] = 0.26; 95% CI, 0.07–0.89). The incidence of right cerebral infarction also decreased (1.3% vs 0.27%), although the difference did not reach statistical significance (p = 0.09; odds ratio = 0.21; 95% CI, 0.05–0.95), showing a consistent trend toward reduction.
Conclusions: The right upper hemisphere is particularly vulnerable to ischemic injury during robotic mitral valve repair because of restricted positioning and perfusion disadvantage from femoral cannulation. Our protocol-combining selective axillary cannulation, strategic positioning, and shortened extracorporeal circulation-markedly reduced stroke incidence and offers a practical approach for cerebral protection.
Authors
Ryuta Seguchi (1), Go Watanabe (1), Norihiko Ishikawa (1), Kazuto Miyata (1), Takafumi Horikawa (1), Toru Koakutsu (1), Daiki Yoshiyama (1), Shigeyuki Tomita (1), Toshiya Ohtsuka (1)
Institutions
(1) NewHeart Watanabe Institute, Tokyo, NA
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Poster Presenter
Ryuta Seguchi, NewHeart Watanabe Institute
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Tokyo, ON
Japan
Objective: To evaluate how compliance with guideline-directed medical therapy (GDMT) modifies the incremental benefit of bilateral (BIMA) versus single (SIMA) internal mammary artery grafting in isolated coronary artery bypass grafting (CABG).
Methods: Adults ≥18 years who underwent isolated CABG with SIMA or BIMA between 2011-2024 were retrospectively analyzed. Exclusions included prior CABG, emergent CABG or pre-operative mechanical circulatory support, dialysis, and residence >50 miles from the nearest satellite facility. Prescription records were used to determine GDMT compliance, defined as ≥80% days covered per year for all eligible drugs (statin, beta-blocker, antiplatelet/P2Y12). The primary endpoint was time to first major adverse cardiac event (MACE: all-cause mortality, myocardial infarction, or repeat revascularization). Cox regression assessed associations among conduit strategy, GDMT compliance, and their interaction, adjusting for demographics and comorbidities.
Results: A total of 3616 patients were included (SIMA=3076, BIMA=540). Median follow-up was 7.6 years. Cumulative MACE was significantly higher with SIMA than with BIMA, reaching 44.5% versus 32.1% at 10 years (log-rank p<.001). Cumulative mortality at 10 years was 28.6% for SIMA versus 19.1% for BIMA (log-rank p<.001). BIMA independently reduced MACE risk by 28% (adjusted HR 0.72 [0.60-0.86], p<.001), and GDMT compliance (≥80%) was associated with a 12% lower hazard of MACE (adjusted HR 0.88 [0.78-0.99], p=.030), however, there was no significant conduit-GDMT interaction (p=.479). Using the SIMA-compliant group as reference, the SIMA-non-compliant group had a 16% higher MACE risk (HR 1.16 [1.02-1.31], p=.023). The BIMA-compliant and BIMA-non-compliant groups had HRs of 0.78 (0.58-1.05, p=.106) and 0.80 (0.64-1.00, p=.0497), respectively, relative to SIMA-compliant patients. GDMT compliance significantly improved late survival among SIMA patients (non-compliance HR 1.25 [1.06-1.48], p=.009), but not within BIMA, likely from limited power in the smaller BIMA subgroups.
Conclusions: GDMT adherence did not significantly impact late survival within the BIMA cohort. Compliance with GDMT significantly improves long-term outcomes only in SIMA CABG patients. The persistence of BIMA's overall survival benefit alongside the additive protection of GDMT emphasizes that optimal surgical conduit selection and sustained medical compliance are complementary determinants of late CABG outcomes.
Authors
KEI KOBAYASHI (1), Xander Jacquemyn (1), Jianhui Zhu (1), Floyd Thoma (1), Derek Serna-Gallegos (1), David Kaczorowski (1), Johannes Bonatti (1), Francis Ferdinand (1), David West (1), Takuya Ogami (1), Irsa Hasan (1), Ibrahim Sultan (1), Danny Chu (1)
Institutions
(1) University of Pittsburgh Medical Center, Pittsburgh, PA
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Poster Presenter
KEI KOBAYASHI, UPMC Presbyterian
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PA
United States
Objective: Valve-sparing aortic root replacement (VSARR) provides durable outcomes in bicuspid aortic valve (BAV) disease but is technically demanding and performed only by highly experienced surgeons due to procedural complexity and difficulty in achieving uniform root geometry. To address these limitations, we developed a novel three-dimensional (3D) reinforced ringed-graft designed to restore root geometry in a standardized configuration with rigid annular support. This study compared its hemodynamic performance with the conventional David reimplantation technique.
Methods: A semi-rigid 3D-printed photopolymer frame (A) replicating the valvulo-aortic junction was integrated into a 28-mm woven polyester graft (B). Five porcine hearts were studied in a validated ex-vivo left heart simulator after creation of a BAV model by fusing two cusps to form a pseudo-raphe. For the novel procedure, multiple mattress sutures were placed around the trimmed aortic root (C), passed through the device, and tied to seat it onto the root, requiring only a single-layer suture line (D). Each root underwent both the novel VSARR and David reimplantation in randomized order to equalize baseline conditions. Hemodynamic performance - including aortic regurgitation (AR), effective orifice area (EOA), transvalvar pressure gradient, and leaflet kinematics - was analyzed by left-heart simulator and with high-speed leaflet tracking.
Results: The novel VSARR demonstrated significantly lower AR fraction (7.8 ± 2.9% vs 18.5 ± 7.3%, p = 0.03, E), larger EOA (1.47 ± 0.19 cm² vs 1.19 ± 0.21 cm², p = 0.03, F) and a trend toward lower transvalvar pressure gradient (5.1 ± 1.4 mmHg vs 8.6 ± 2.3 mmHg, p = 0.16, G) compared with conventional reimplantation. Leaflet opening, closing, and acceleration dynamics were comparable between groups.
Conclusions: In an ex-vivo BAV model, VSARR using the novel 3D reinforced ringed-graft achieved superior hemodynamic outcomes with lower AR fraction and larger EOA compared with the conventional reimplantation technique. By enabling seating of the graft with a simplified single-layer suture line, this device may streamline VSARR, enhance reproducibility beyond only the most experienced surgeons. Further in vivo and clinical studies are warranted.
Authors
Masafumi Shibata (1), Perry Choi (2), Amit Sharir (3), Chris Huynh (4), Riya Nilkant (5), Matthew Park (6), Sarah Chen (7), Michael Ma (8), Y. Joseph Woo (3), Joon Bum Kim (9)
Institutions
(1) Stanford University, Sunnyvale, CA, (2) Stanford University, Palo Alto, CA, (3) Stanford University, Stanford, CA, (4) Stanford University School of Medicine, Campbell, CA, (5) Stanford University School of Medicine, CA, (6) Stanford University School of Medicine, Palo Alto, CA, (7) University of Michigan, Ann Arbor, MI, (8) Stanford University School of Medicine, Stanford, CA, (9) Asan Medical Center, Seoul, NA
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Poster Presenter
Masafumi Shibata, Stanford University
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Sunnyvale, CA
United States
Objective: To study nationwide trends and outcomes of multiorgan heart transplantation (HTx) before and after the 2018 change in the US heart allocation system.
Methods: Organ Procurement and Transplantation Network data was used to identify adult patients who underwent HTx between 01/01/2011 and 06/30/2025 (Single Heart (SH) = 37273, Heart-Kidney (HK) = 2810, Heart-Liver (HLi) = 586, Heart-Lung (HLu) = 483). Baseline characteristics, in-hospital outcomes and one-year survival (adjusted and unadjusted) were compared before and after the allocation system change.
Results: Between 2011 and 2025, 114/152 US HTx centers performed multiorgan HTx. HLi and HLu had higher overall one-year mortality compared to SH (SH: 8.11%; HK: 11.46%, adjusted p=0.1; HLi: 15.36%, p<0.001; HLu: 17.18%, p<0.001). Rates of all types of multiorgan HTx increased in the new allocation era (p<0.01, Figure 1). HK recipients in the new allocation era were more likely to have been on extracorporeal membrane oxygenation (ECMO) support at the time of HTx (1% vs 6.5%, p<0.001) and had shorter waitlist time (87 vs 36 days, p<0.001). While dialysis before discharge (28.6% vs 37.2%, p<0.001) and longer inpatient stay (20 vs 21 days, p=0.005) were more prevalent in the new era, one-year mortality remained unchanged (11.8% vs 11.3%, adjusted HR: 0.92 [0.71-1.18], p=0.5). In the new allocation era, HLi recipients were older (44 vs 49 years, p<0.001), more likely to be on ECMO support (0.6% vs 5.4%, p=0.013), and had fewer waitlist days (109 vs 60, p<0.001). Like HK, HLi showed increased rates of post-HTx dialysis (23% vs 36%, p=0.003) and length of stay (23 vs 28 days, p=0.003), but no significant difference in adjusted one-year mortality (10.9% vs 17.3%, HR: 1.68 [0.95-2.97], p=0.07). HLu recipients in the new allocation era were more frequently on ECMO (16.2% vs 28.8%, p=0.003) and had a shorter waitlist time (72 vs 41 days, p=0.002). In-hospital outcomes and one-year mortality were comparable between the allocation eras (19.8% vs 15.8%, HR 0.77 [0.48-1.22], p=0.268).
Conclusions: The new allocation system achieved an increase in multiorgan HTx in patients with higher clinical acuity and a significant reduction in waitlist time while maintaining survival rates at one year.
Authors
Koray Potel (1), Sean Nguyen (1), Cole Myers (1), Emma Schaffer (2), Stephen Huddleston (3), Tamas Alexy (1), Rebecca Cogswell (1), Rosemary Kelly (1), Andrew Shaffer (2), Ranjit John (2)
Institutions
(1) University of Minnesota, Minneapolis, MN, (2) University of Minnesota Medical Center, Minneapolis, MN, (3) University of Minnesota Medical School, Saint Paul, MN
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Poster Presenter
Koray Potel, University of Minnesota
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Minneapolis, MN
United States
Objective: Open total arch repair of complex aortic pathologies is associated with significant risk of stroke and recurrent laryngeal nerve injury. A novel sutureless graft could potentially facilitate such repairs by minimizing circulatory arrest time and limiting the need for arch mobilization. We report late outcomes of our single center experience with the use of a novel sutureless anastomosis revascularization technique for debranching of supra-aortic vessels during hybrid repair.
Methods: Retrospective study of 65 patients with complex aortic pathologies who underwent classic hybrid arch (no circulatory arrest) debranching, Zone 1, Zone 2, or Zone 3 arch replacement with antegrade cerebral perfusion (ACP). Supra-aortic bypasses to vessels <10 mm in diameter using sutureless arch anastomosis were performed with a Gore Hybrid stent graft. Underlying aortic pathology was acute Type A dissection in 32 patients, chronic aortic dissection in 14, aortic arch aneurysm in 17, and ruptured aortic arch in 2 patients.
Results: Average age was 62.5 ± 11.0 years (range, 27-87 years). 26.2% of patients were female. Seventy-four grafts were implanted in 65 patients using the sutureless technique, including isolated debranching of the left common carotid artery (LCCA) in 83%, left subclavian artery (LSA) in 1.5%, right common carotid artery (RCCA) in 1.5%, concomitant LCCA and LSA in 6.2%, concomitant LCCA and RCCA in 6.2%, and concomitant LCCA and Left Vertebral Artery in 1.5%. Technical success was 100%. Mean cerebral ischemia time was 30.3 ± 12.0 minutes (range, 3-71 min). Four patients had perioperative stroke. No early (<30 days) graft occlusion occurred. There were 2 late graft occlusions, one presenting with TIA at 2years and managed with a carotid subclavian bypass, the second was an asymptomatic occlusion that occurred in the setting of a severe ascending and arch graft infection at 5 years postop. Overall freedom from sutureless graft occlusion was 95%(88.1-100%) at 5 years. There were no strokes related to loss of graft patency.
Conclusion: Hybrid repair using the novel sutureless anastomosis technique is a reasonable and effective option for treatment of complex aortic arch pathologies which simplifies technique and minimizes cerebral ischemia time. Late outcomes are favorable to traditional sewn anastomoses.
Authors
Brittany Cannon (1), Nimesh Desai (2), Yu Zhao (2), Joseph Bavaria (3)
Institutions
(1) The University of Pennsylvania, Philadelphia, PA, (2) University of Pennsylvania, Philadelphia, PA, (3) Thomas Jefferson University, Philadelphia, PA
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Poster Presenter
*Nimesh Desai, University of Pennsylvania
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Philadelphia, PA
United States
Objective: Left main coronary artery (LMCA) aneurysms are the rarest form of coronary artery aneurysms. Due to their rarity, the optimal surgical strategy remains undefined. We sought to evaluate the clinical characteristics, operative management, and outcomes of patients with LMCA aneurysms.
Methods: Between 01/2006-01/2025, 11 patients underwent surgical treatment for LMCA aneurysms at our institution. Clinical presentation, imaging, operative findings, aneurysm morphology, and postoperative outcomes were analyzed. The primary endpoint was all-cause mortality at 30, 90, and 180 days, and at 1 and 5 years.
Results: Mean age at surgery was 62±10 years; 4 patients (36%) presented with angina, and 2 had >50% affected vessel obstruction. Etiologies included atherosclerotic (n=4,36%), infective (n=2,18%), fistula-related (n=1,9.1%) and idiopathic (n=4,36%). LMCA diameter ranged from 6.2 mm to 59 mm with a median of 15 mm. Most aneurysms were distal (n=5, 46%), followed by proximal (n = 3, 27%), of which 2 involved the ostium. Two were diffuse (18%), and one was in the mid LMCA (9.1%). Fusiform morphology predominated (n=7, 64%), followed by saccular (n=3, 27%) and ectatic (n=1, 9.1%). Intramural thrombus was present in 2 patients (18%) and calcification in 4 (36%). Surgical approaches included aneurysm excision-ligation with CABG (n=6, 55%), CABG alone (n=3, 27%), plication alone (n=1, 9.1%), and fistula-ligation alone (n=1, 9.1%). The fistula-ligation only was feasible due to the small diameter of the LMCA aneurysm without significant atherosclerosis requiring CABG. In-hospital mortality occurred in 1 patient (9.1%) who underwent redo sternotomy and debridement for an infected coronary artery pseudoaneurysm. Following excision-ligation with CABG of the LMCA, patient left the operating room on mechanical circulatory support. His condition continued to deteriorate, progressing to uncontrollable disseminated intravascular coagulation and multi-organ failure. Survival at 30, 90, and 180 days was 91%, 82%, and 73%, respectively; at 1 and 5 years it was 73% and 64%. No deaths beyond 30 days were procedural related.
Conclusion: LMCA aneurysms remain rare and are often identified incidentally during evaluation for other cardiac conditions. Distal fusiform aneurysms were the most common presentation. Ligation with CABG was the predominant operative strategy and was associated with good perioperative outcomes and low in-hospital mortality.
Authors
Aryan Pasricha (1), Philip Leib (1), Mahmoud Alshneikat (1), Tarek Nukta (1), Jonathan Putnam (2), Eugene Blackstone (1), Eric Roselli (1), Faisal Bakaeen (1)
Institutions
(1) Cleveland Clinic, Cleveland, OH, (2) Case Western Reserve University School of Medicine, Cleveland, OH
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Poster Presenter
Aryan Pasricha, Cleveland Clinic
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Cleveland, OH
United States
Objective
To compare the early and late outcomes of hemiarch vs total arch repair (TAR) in acute type A dissection (ATAAD).
Methods
Of 2326 patients with ATAAD from 2003–2020, 115 had hemiarch repair (HAR group) and 2133 had TAR with frozen elephant trunk (FET). Early and late outcomes of HAR (n=204) and TAR (n=110) were compared in a cohort of 314 patients propensity score matched at a 1 : 2 ratio by age, gender, year of surgery, and malperfusion using 0.2 calipers without replacement.
Results
Two groups were comparable at baseline and operative data (all P>0.05), except that HAR group had shorter CPB, cross-clamp and cerebral perfusion times (173 vs 198; 90 vs 112; 19 vs 26 min, all P<0.001) and more extra-anatomic bypass (EAB) (4.5% vs 1%, P=0.054). Operative mortality (10% [11/110] vs 8.3% [17/204], P=0.621) and morbidity were comparable in 2 groups (Table 1), except a higher incidence of spinal cord injury (SCI) in TAR group (2.9% vs 0, P=0.095).
Follow-up was 99.6% (284/285) at mean 11.2±4.9 years (range, 0.1–22.0). Late death occurred in 19 and 42 patients of HAR and TAR groups at median 7.2 and 7.9 years (interquartile range [IQR] 3.0–12.1 and 4.0–10.0), respectively. Leading cause of late death was distal aortic rupture in HAR group (36.8% [7/19] vs 7.1% [3/42], P=0.006), and non-cardiac/aortic reason in TAR group (5.3% [1/19] vs 33.3% [14/42], P=0.019). Death from stroke was seen in TAR groups only (14.3% [6/42] vs 0% [0/42] P<0.001). Distal aortic reoperation was done in 15 and 10 patients of HAR and TAR groups at median 3.5 and 2.5 (IQR 2.1–6.6 and 0.7–9.1) years, which was more common in HAR (15.2% [15/99] vs 5.4% [10/186], P=0.005). In HAR group, 6 had thoracoabdominal aortic aneurysm repair and 5 had TAR+FET, vs 7 and 0 in TAR group.
At 20 years, survival were 68.1% and 65.6% (95% confidence interval [CI], 60.4–75.8% and 60.2–71.0%) and freedom from reoperation were 86.6% and 88.7% (95% CI, 82.6%–90.6% and 83.5–93.9%) in HAR and TAR groups (P=0.542 and P=0.131), respectively, while HAR group showed significantly higher incidence of late distal aortic dilation and rupture (33% vs 10%; 95% CI, 18–48% vs 4.2–19%) (P<0.001).
Conclusions
Although HAR and TAR showed comparable early and late survival rates and TAR had higher risk of SCI, TAR was associated with reduced risks of late distal aortic dilatation and rupture. These results argue favorably for the use of the TAR+FET technique in selected patients with ATAAD.
Authors
Wei-Guo Ma (1), Su-Wei Chen (2), Yu Chen (3), Wentao Dong (2), Xiaoyang Zhang (2), Zhiyu Qiao (4), Jun-Ming Zhu (5), Li-Zhong Sun (6)
Institutions
(1) Yale School of Medicine, New Haven, CT, (2) Beijing Anzhen Hospital Capital Medical University, Beijing, Beijing, (3) Beijing Anzhen Hospital, Beijing, Please Select, (4) Beijing Anzhen Hospital of Capital Medical University, Beijing, NA, (5) N/A, Beijing, Beijing, (6) N/A, Beijing, China
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Poster Presenter
Su-Wei Chen, Beijing Anzhen Hospital Capital Medical University
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Beijing, Beijing
China
Objective: Ischemia-reperfusion injury (IRI) during heart transplantation contributes to early graft dysfunction through cellular injury and inflammation. Mitsugumin 53 (MG53) is an endogenous membrane-repair protein that modulates the inflammasome activation. We hypothesized that IRI would be amplified in the absence of circulating MG53 and mitigated by increased MG53 expression.
Methods: Wild-type (WT) donor hearts were heterotopically transplanted into WT, MG53-knockout (MG53KO), and transgenic plasma-overexpressed MG53 (tPA) recipient mice following 15 minutes of warm ischemia and 4 hours of cold storage at 4 °C. Mice were monitored for 24 hours (acute phase) and up to 14 days (resolution phase) post-transplantation. Beating scores were recorded daily as the primary functional endpoint. Plasma and graft tissues were analyzed for markers of inflammation and cellular injury, including IL-1β, IL-18, and lactate dehydrogenase (LDH).
Results: A total of 31 mice were included (15 sacrificed at 24 hours, 16 at 14 days). MG53KO recipients exhibited significantly higher plasma IL-1β concentrations compared with WT (p < 0.01) and tPA recipients (p < 0.001). By 14 days, IL-1β levels had declined and no longer differed among groups (Fig. 1a). At 24 hours, LDH levels were significantly elevated in MG53KO and WT recipients compared to WT donor no-transplant controls (p < 0.01), but not in tPA recipients. By 14 days, LDH levels decreased comparably in all cohorts. IL-18 levels did not differ significantly between groups at either time point. WT recipients demonstrated consistently higher beating scores throughout follow-up. By day 5, MG53KO graft beating scores declined significantly compared to WT (2.8 vs 4.0, p < 0.05), and by day 11, tPA grafts declined compared with WT (2.5 vs 3.8, p < 0.05) (Fig. 1b).
Conclusions: In this murine heart transplantation model of allograft warm ischemic injury, the absence of MG53 led to heightened inflammatory response and reduced graft function. Overexpression of MG53 conferred early protection during the acute phase of IRI, attenuating cellular inflammation and preserving graft activity. These findings suggest that MG53 is a promising therapeutic target for mitigating IRI in heart transplantation.
Authors
Tony Boualoy (1), Dhiaeddine Djabri (2), Martin Walsh (3), Zhentao Zhang (4), Xi Wang (4), Yong Gyu Lee (5), Jung Lye Kim (5), Doug Gouchoe (2), Sylvester Black (6), Hua Zhu (4), Bryan Whitson (7)
Institutions
(1) The Ohio State Medical center and Nationwide Childrens Hospital, Pickerington, OH, (2) The Ohio State Medical center and Nationwide Childrens Hospital, Columbus, OH, (3) Ohio State Wexner Medical Center, Columbus, OH, (4) The Ohio State University Wexner Medical Center, Columbus, OH, (5) COPPER Lab (Collaboration for Organ Perfusion, Protection, Engineering, and Regeneration Laboratory), Columbus, OH, (6) 5Department of Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, (7) Ohio State University, Columbus, OH
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Poster Presenter
Tony Boualoy, The Ohio State Medical center and Nationwide Childrens Hospital
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Pickerington, OH
United States
Background: Metabolomics characterizes myocardial metabolism and reveals shifts linked to ischemia-reperfusion injury into donor heart recovery. This study compares metabolic signatures between DCD and DBD hearts recovered with normothermic regional perfusion (NRP) vs ex-vivo machine perfusion (EVMP).
Methods: Adult heart transplant recipients undergoing either DBD or DCD transplantation were enrolled. Coronary sinus blood (CSB) was collected to capture metabolites reflective of myocardial metabolism at time of graft implantation. Samplels were processed using standardized protocols and analyzed by institutional metabolomics and lipidomics core using mass-spectrometry based profiling. DCD samples were further stratified by NRP vs EVMP. Data were pre-processed, normalized, and analyzed using partial least-squares discriminant analysis (PLS-DA) to assess clustering by donor type and recovery method. Variable importance in projection (VIP) scores identified key metabolites and lipid species contributing to group discrimination.
Results: 29 CSB samples were analyzed (16 DCD, 13 DBD). Among 9 DCD donors, there were 9 NRP and 7 EVMP donors. PLS-DA demonstrated clear metabolic separation between DCD and DBD profiles in metabolomics and lipidomics datasets. Variable importance in projection (VIP) scores identified key metabolites driving this distinction. Compared with DBD grafts, DCD grafts showed lower levels of included D-arabitiol/xylitol/ribitol (DC 0.54, p<0.01), L-glutamine (FC 0.67, p<0.01), thymidine (FC 0.48, p<0.01), L-arginine (FC 0.55, p=0.006), markers linked to energy metabolism, cellular repair, and nitric oxide synthesis. DCD grafts also showed higher levels of mannitol/sorbitol/glucitol/iditol (FC 12.53, p<0.01), associated with oxidative stress during reperfusion.
Lipidomic analysis revealed significant changes in triglycerides and fatty acid species, including TG(22:1_16:0_18:0) (FC 0.42, p<0.05) and FA(20:1)(FC 1.51, p<0.05).
Within the DCD cohort, multivariate modeling with PLS-DA showed distinct clustering between NRP and EVMP grafts. Discriminatory metabolites included D-rhamnose (FC 0.012, p<0.001) and DG(P-6:0_16:0) (FC 0.35, p<0.001), reflecting divergent reperfusion metabolism between groups.
Conclusion: Distinct metabolomic and lipidomic profiles were observed in DCD compared to DBD, and NRP vs EVMP. Metabolic profiling at time of reperfusion may enable identification of at-risk grafts and guide optimization of recovery.
Authors
Elizabeth Bashian (1), Sariah Hyacinth (2), Nicholas Teman (3), Michael Cain (4), Benjamin Kopecky (2)
Institutions
(1) University of Colorado Anschutz Medical Center, Aurora, CO, (2) University of Colorado Anschutz Medical Campus, Aurora, CO, (3) University of Colorado School of Medicine, CO, (4) University of Colorado Hospital, Denver, CO
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Poster Presenter
Bo Chang Wu, University of Colorado Anschutz Medical Center
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Aurora, CO
United States
Objective: Artificial intelligence may have significant potential to improve quality of mitral valve repair, optimize surgical training, and ultimately enable autonomous robotic surgery. This study aims to develop an artificial intelligence-powered intra-operative strategy support system for mitral valve repair.
Methods: All patients undergoing degenerative mitral valve repair with intraoperative video and preoperative echocardiogram images from January 2020 to December 2024 in a single center was enrolled in this study. The dataset was divided into training set, validation set and test set at an 8:1:1 ratio. This system learned to map patients' multimodal data (composed of intraoperative video, preoperative echocardiogram images and baseline information) to anatomy identification, pathology assessment, surgical technique planning and field demarcation. A self-supervised machine learning approach and a hybrid Convolutional Neural Network-Swin dual-stream network were utilized as the core deep learning architecture. For discrepancy analysis, the model-generated results were compared to that from expert surgeons as the gold standard.
Results: The study enrolled 305 patients, who were assigned to training set (n=241), validation set (n=31), and test set (n=33). Anatomy identification achieved robust performance (anterior leaflet: Dice scores=90.2%; posterior leaflet: Dice scores=89.1%; annulus: Dice scores=83.6%; chordae: Dice scores=87.3%; papillary muscles: Dice scores=85.4%). Pathology assessment demonstrated competent classification accuracy (anterior leaflet: exact accuracy=82.4%; posterior leaflet: exact accuracy=80.1%; annulus: exact accuracy=78.9%; and chordae: exact accuracy=82.2%). Surgical technique planning showed significant concordance, with 93.9% of the test set (31/33) being judged practicable with expert surgeons (AUC=0.78; Cohen's κ=0.862, p<0.001). Surgical field demarcation attained adequate performance with Dice score of 81.3%.
Conclusions: This preliminary artificial intelligence-driven system enabled precise anatomy identification, pathology assessment, surgical technique planning and field demarcation for mitral valve repair.
Authors
Yu Han (1), Jiaxi Zhu (2), Haozhe Wang (3), Yanzai Zhou (4), Qiang Zhao (5), Xiaofeng Ye (6)
Institutions
(1) Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, NA, (2) Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, (3) Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Shanghai, NA, (4) Ruijin Hospitai, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Shanghai, NA, (5) Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, (6) Shanghai Jiaotong University School of Medcine, SHANGHAI, Shanghai
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Poster Presenter
Yu Han, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
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Shanghai, Shanghai
China
Objective:
Impaired long-term outcomes after surgical aortic valve replacement result from patient-prothesis mismatch. Aortic root enlargement (ARE) techniques have been proposed to enable the implantation of larger prosthetic valves. However, increasing the valve size by two to three sizes may cause the valve to tilt to some degree, which could affect transvalvular flow haemodynamics and aortic wall shear stress. Therefore, this study aimed to assess aortic flow patterns in patients after the novel Yang ARE technique, comparing them to those of patients with size-matched bioprostheses in 4D flow magnetic resonance imaging (MRI).
Methods:
A total of ten patients underwent MRI at 3 Tesla 9.2±6.6 months following a Y-incision procedure (Yang; n=5) or bioprosthetic valve replacement with an INSPIRIS RESILIA valve (control group; n=5). The median upsizing during the Y-incision procedure was two valve sizes. The analysis planes were positioned at the level of the sinotubular junction (STJ), the mid-ascending aorta (mid-AAo) and the proximal arch (prox-AA). Flow displacement (FD) was estimated as a measure of flow eccentricity and wall shear stress (WSS) was also calculated.
Results
The mean age at the time of the procedure was significantly higher in the Yang group (67.8±8.6 years) than in the control group (48.4±6.9 years); p=0.002. One redo surgery was performed in each group. The mean gradient was 9.6±4.2 mmHg in the Yang group and 9.8±2.8 mmHg in the control group (p=0.931). 4D flow MRI revealed similar postoperative flow displacement in both groups at all levels (Yang vs. control): STJ (0.12±0.09 vs. 0.13±0.09;p=0.874), mid-AAo (0.33±0.09 vs. 0.38±0.04;p=0.343), and proximal-AA (0.34±0.07 vs. 0.37±0.04;p=0.427). WSS analysis also showed comparable parameters at all three levels: STJ: 0.46±0.15 N/m² vs. 0.36±0.12 N/m² (p=0.237); midAAo: 0.73±0.42 N/m² vs. 0.71±0.25 N/m² (p=0.923); proxAA: 0.65±0.19 N/m² vs. 0.56±0.21 N/m² (p=0.509).
Conclusion
The Y-incision aortic annular enlargement produces similar transvalvular flow patterns and wall shear stress in the ascending aorta compared to regular bioprosthetic valve replacement, as demonstrated by 4D flow MRI. Therefore, our preliminary data suggests that even excessive oversizing does not result in impaired haemodynamics. Implanting a larger bioprosthetic valve should be the ultimate goal for optimizing the long-term management of patients with aortic valve disease.
Authors
Johannes Petersen (1), Lukas Maximilian Huber (2), Harun Sarwari (3), Meltem Belik (3), Ashkan Naebian (4), Peter Bannas (5), Hermann Reichenspurner (1), Alexander Lenz (2), Evaldas Girdauskas (6)
Institutions
(1) University Heart & Vascular Center Hamburg, Hamburg, Hamburg, (2) Department of Radioloy, University Hospital Eppendorf, Hamburg, NA, (3) University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, NA, (4) University Heart & Vascular Center Hamburg, Hamburg, NA, (5) Department of Radioloy, University Hospital Eppendorf, Germany, Hamburg, NA, (6) University Hospital Augsburg, Augsburg, Germany
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Poster Presenter
Johannes Petersen, University Heart & Vascular Center Hamburg
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Hamburg, Hamburg
Germany
Objective
Bilateral internal thoracic artery (BITA) grafts are associated with superior long-term patency and reduced late mortality. Nevertheless, no investigation has benchmarked long-term outcomes of off-pump BITA coronary artery bypass grafting (CABG) against national life expectancy in a middle-income country. This study aimed to determine whether BITA grafting normalizes life expectancy.
Methods
We included all adults undergoing exclusive off-pump BITA CABG in "T graft" configuration, for multivessel disease at a tertiary center (2003–2023). Patients were followed through hospital registries and telephone contact. Observed survival was compared with age-, sex-, and calendar-matched national life-table survival (National Institute of Statistics) using the Ederer II relative survival method. Cox proportional hazards regression models were applied to compare time to death according to age and diabetic status. Also, we assess the need of postoperative angiography (PO-angio) at follow-up with a cumulative incidence function (CIF), treating death as a competing event.
Results
Among 4,495 patients (mean age 64 ± 9 years; 8.3% women; 31,475 patient-years; 1,199 deaths), relative survival matched the background population at 1 year (1.00; 95% CI 0.99–1.01), peaked at 10 years (1.13; 1.09–1.18), and remained 0.99 (0.89–1.09) at 20 years. By sex, men (n=4,120) showed sustained benefit-relative survival 1.10 at 10 years and 1.04 at 15 years-whereas women (n=375) fell below unity by year 8 and to 0.52 at 20 years, reflecting excess mortality (Figure 1). Age ≥65 years and diabetes were independently associated with higher postoperative mortality (HR 4.99; 95% CI: 4.33–5.75; p<0.01 and HR 1.28; 95% CI: 1.10–1.48; p<0.0, respectively). Competing-risk analysis showed a low cumulative incidence of PO-angio: 1% at 1 year (95% CI 0.7–1.4%), 4.8% at 5 years (4.1–5.6%), 8.8% at 10 years (7.7–9.9%), and 14.7% at 20 years (13.0–16.5%). Graft patency rates were: LITA-LAD 95% (N=318), RITA-CX 90% (N=302), and RITA-RCA 83% (N=278), with no sex differences.
Conclusions
In this 20-year cohort, men undergoing exclusive off-pump BITA CABG achieved survival comparable to the general population. Women, however, experienced persistent excess mortality, as well as patients older than 65 years and with diabetes. PO-angio remained below 15% at 20 years in both sexes, confirming the durability of BITA grafting in a middle-income country.
Authors
Daniel Navia (1), Mariano Vrancic (1), Fernando Piccinini (1), Ivan Huespe (2), Leandro Seoane (1), Juan Costabel (1), Alberto Dorsa (1), Marcelo Trivi (1)
Institutions
(1) ICBA, CABA, Buenos Aires, (2) Hospital Italiano, CABA, Buenos Aires
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Poster Presenter
*Daniel Navia, ICBA
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Buenos Aires, Buenos Aires
Argentina
Objective: In valve-sparing aortic root replacement (VSARR), the restoration of physiologic hemodynamics necessitates accurate reconstruction of the aortic root to its native geometry. Specifically, the commissural height relative to the annular diameter is critical to establishing proper aortic leaflet coaptation. This ratio, however, has not been well defined and is typically guided by surgeon experience. To address this, we investigated the optimal ratio using a novel 3D-printed coronet-shaped ring sewn into a woven polyester graft to standardize commissural positioning relative to annular diameter.
Methods: Five porcine aortic roots (median annular diameter 25 mm, ranging 23-27 mm) were reimplanted into our novel ringed grafts with height-to-diameter ratios of 0.85, 1.00, and 1.15 (Figure A, B) in a randomized order. Hemodynamic testing was performed on an ex vivo left heart simulator under physiologic conditions. The primary variable of interest was aortic regurgitation fraction (ARF). Secondary measurements included mean transaortic gradient, effective orifice area (EOA), and transvalvular energy loss throughout the cardiac cycle. Leaflet kinematics (opening/closing velocity and relative force) were also assessed.
Results: Across all measured variables, the 1.00 ratio consistently outperformed the 0.85 and 1.15 ratios: ARF was lowest with 1.00 (1.52±0.88%) compared with 0.85 (4.39±4.45%) and 1.15 (2.95±2.42%) (P<0.001, Figure C); mean transaortic gradient was most favorable at 1.00 (21.1±8.1 mmHg vs. 29.3±11.4 and 27.7±12.6 mmHg, P<0.001); EOA was largest with 1.00 (1.74±0.70 cm² vs. 1.50±0.43 and 1.29±0.18 cm², P<0.001); transvalvular energy loss was minimized at 1.00 (127.2±84.8 mJ vs. 192.9±91.7 and 281.5±29.9 mJ, P<0.001). Leaflet velocities and forces were comparable among groups (P>0.05).
Conclusions: A commissural height-to-annular diameter ratio of 1.00 best minimizes ARF, optimizes pressure gradients and EOA, and reduces energy loss without impairing leaflet dynamics. These findings establish 1.00 as a geometric target for VSARR and support the development of standardized ringed grafts engineered to restore physiologic hemodynamics.
Figure. (A) The 3D-printed novel rings with commissural height-to-annular diameters of 0.85, 1.00, and 1.15. (B) The porcine aortic root is reimplanted into a 1.00 ringed graft using mattress sutures and subsequently mounted on our ex vivo evaluation platform. (C) ARF among 0.85, 1.00, and 1.15 ringed grafts.
Authors
Chris Huynh (1), Seung Hyun Lee (1), Masafumi Shibata (1), Matthew Park (1), Stefan Elde (1), Michael Paulsen (2), Joon Bum Kim (3), Y. Joseph Woo (1)
Institutions
(1) Stanford University, Stanford, CA, (2) Cottage Health, Santa Barbara, CA, (3) Asan Medical Center, Seoul, Korea
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Poster Presenter
Chris Huynh, Stanford University School of Medicine
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Campbell, CA
United States
Objective
The ultrasonic bone scalpel (BS) is increasingly applied in spinal and orthopedic surgery because its blunt, high-frequency vibrating blade selectively cuts bone while sparing soft tissues such as nerves and vessels. Recently, BS has been introduced for redo sternotomy in cardiac surgery, as it can safely separate the sternum from adhered cardiac tissues and great vessels. However, the high-frequency vibration of the blade generates heat, posing a potential risk of thermal injury to tissues adherent to the sternum. The optimal power settings and operative technique for safe use in redo sternotomy have not been established. This study aimed to determine the appropriate power levels and handling techniques for safe BS use during redo sternotomy using an ex vivo sheep heart model.
Methods
Whole sheep hearts were harvested, and ventricular tissue blocks were prepared. Samples were divided into two groups according to blade handling technique: (1) Holding - the blade kept stationary on the tissue, and (2) Quick touch - rapid, light, repetitive contact. Each technique was tested at three power levels (40, 60, and 100). The extent of tissue injury was assessed macroscopically by measuring the area of visible damage and histologically by evaluating thermal injury depth.
Results
Macroscopic analysis showed no visible scar or thermal injury in the quick touch group, even at high power. In contrast, the holding group demonstrated clear scar formation, which increased proportionally with power level. Histological examination confirmed that thermal injury depth correlated with power in the holding group but was absent in the quick touch group.
Conclusion
During redo sternotomy, the ultrasonic bone scalpel offers a significant advantage over conventional sternal saws by reducing the risk of injury to cardiac tissues and great vessels. Although excessive power or prolonged contact can cause thermal injury, using the quick touch technique-brief, repetitive blade contact-maintains safety even at high power. When applied properly, BS is a useful and safe device for minimizing cardiac and vascular injury during redo sternotomy.
Authors
Yuta Tsuchida (1), Riya Gandhi (2), Narutoshi Hibino (3)
Institutions
(1) University of Chicago, Chicago, IL, (2) the university of chicago, chicago, IL, (3) Advocate Children's Hospital, Chicago, IL
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Poster Presenter
Yuta Tsuchida, University of Chicago
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Chicago, IL
United States
Objective: Inflammation in peri-vascular adipose tissue (PVAT) is known to contribute to aortic aneurysm (AA) pathogenesis. Mitophagy, the process of mitochondrial turnover, in PVAT may be a driver of disease progression. Parkin, an E3 Ubiquitin Ligase central to mitophagy, has already been identified as a driver of diet and age-induced adipogenesis in murine models. Thus, we investigated Parkin's role in PVAT inflammation and resultant AA phenotype.
Methods: Wild-type (WT) and Parkin knockout (PKO) mice underwent AA induction via laparotomy and topical elastase application to the abdominal aorta. AA size was measured at 14-days. Next, WT mice receiving WT fat transplant atop their aorta (WT-WT) and WT mice cross transplanted with PKO fat (WT-PKO) underwent elastase-induced AA generation. Similarly, PKO mice with transplanted PKO fat (PKO-PKO) and PKO mice cross transplanted with WT fat (PKO-WT) underwent AA induction. All experiments were conducted on both sexes. Murine white adipose tissue was utilized for all fat transplants.
Results: WT-WT fat transplanted mice demonstrated exaggerated AA growth compared to WT mice (male: 29.8% increase, p=0.008, female: 103.2% increase, p<0.0001) [Figure 1A]. However, WT-PKO mice, demonstrated attenuated growth compared to WT-WT mice (male: 94.6% decrease & female: 127.4% decrease, p<0.001 for both sexes) [Figure 1B & 1C].
In males, PKO-WT mice demonstrated decreased AA growth compared to PKO mice (males: 53.8% decrease, p=0.0317). Female PKO-WT mice demonstrated augmented AA size compared to PKO mice (females: 43.2% increase, p=0.1429). However, this cohort was affected by high mortality. Both male and female PKO-WT mice showed significantly higher mortality compared to PKO-PKO mice (male: PKO-WT: 40% [4/10] vs. PKO-PKO: 0% [0/10]) (female: PKO-WT: 67% [4/6] vs. PKO-PKO: 0% [0/8]) [p<0.01 for both]. By comparison, PKO-PKO mice all survived and demonstrated attenuated AA size compared to PKO-WT mice, regardless of recipient sex (males: 126.3% decrease p= 0.0081, female: 44.4% decrease, p= 0.0444) [Figure 1D & 1E].
Conclusion:
Silencing Parkin in transplanted fat attenuated AA growth compared to transplanted WT fat, regardless of recipient strain or sex. These findings suggest that Parkin mediated mitophagy may link perivascular adiposity with AA progression.
Authors
Ricky Patil (1), Matthew Kazaleh (1), Keyun Fu (1), Gorav Ailawadi (1), Morgan Salmon (2)
Institutions
(1) University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, (2) N/A, Charlottesville, VA
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Poster Presenter
Ricky Patil, University of Michigan Frankel Cardiovascular Center
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Ann Arbor, MI
United States
Objective
Mitral valve (MV) surgery remains a class I recommendation for patients with symptomatic severe primary mitral regurgitation (MR). For asymptomatic patients with severe primary MR and preserved left ventricular (LV) function, surgical treatment is currently a class II recommendation. However, the ultrastructural changes in the left ventricular myocardium of these asymptomatic patients remain unclear.
Methods
Thirteen patients with severe MR were enrolled in this study, eight of whom were symptomatic, and five asymptomatic. Three donor hearts were used as controls. LV biopsies were obtained and processed for transmission electron microscopy (TEM). TEM images were acquired at 10,000x and 20,000x magnification. Quantitative analysis was performed using the ImageJ software. Statistical comparisons were made using analysis of variance with post-hoc correction. Statistical significance was defined as p<0.05. This study was approved by the Institutional Review Board.
Results
Qualitatively, myofibrillar disarray, as well as Z-line thickening and disruption, was observed in patients with severe MR, regardless of symptoms, compared with controls. Quantitatively, the sarcomere length was greater in controls (1.63±0.26µm) compared with symptomatic (1.31±0.34µm, p=0.001) and asymptomatic patients (1.38±0.22µm, p=0.001). The mitochondria area was also larger in controls (0.34±0.21µm2) than in symptomatic patients (0.27±0.16µm2, p=0.01). The mitochondria cristae thickness was greater in controls (0.05±0.01µm) compared with symptomatic (0.02±0.003µm, p=0.001) and asymptomatic patients (0.02±0.005µm, p=0.001). Similarly, the mitochondrial major-to-minor axis ratio was higher in controls (1.86±0.97) than in symptomatic (1.63±0.51, p=0.01) and asymptomatic patients (1.54±0.56, p=0.001).
Conclusions
In patients with severe asymptomatic MR, ultrastructural changes in the LV myocardium have already occurred to a degree similar to those observed in patients with severe symptomatic MR. Early surgical intervention in asymptomatic patients with severe MR may be prudent to prevent further adverse remodeling.
Authors
Yuanjia Zhu (1), Avi Gupta (1), Seung Hyun Lee (1), Catherine Wu (1), Jinsuh Jung (1), Akshay Venkatesh (1), Sidarth Ethiraj (1), Charles Stark (1), Chris Huynh (1), Shin Yajima (2), Y. Joseph Woo (1)
Institutions
(1) Stanford University, Stanford, CA, (2) Osaka University Graduate of Medicine, Ikeda, NA
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Poster Presenter
Yuanjia Zhu, Stanford University
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Stanford, CA
United States
Objective: Patients undergoing aortic arch replacement are at high risk for neurological complications. While cerebral protection strategies are well established, the impact of preoperative cognitive function remains understudied. This study examined whether cognitive impairment assessed by the Montreal Cognitive Assessment (MoCA) predicts short-term outcomes after aortic arch surgery.
Methods: In this prospective cohort study, 104 patients who underwent aortic arch replacement between September 2023 and March 2025 were enrolled. Preoperative cognition was evaluated using the MoCA, with score <18 defined as moderate to severe cognitive impairment (MSCI). The primary outcome was all-cause mortality during follow-up. Secondary outcomes included prolonged mechanical ventilation (>24 hours) and major perioperative complications. Multivariable logistic and Cox regression models were used, adjusting for confounders.
Results: Seventeen patients (16.3%) had MSCI. They were older and had poorer performance across all cognitive domains. MSCI was independently associated with prolonged ventilation (OR = 34.749; 95% CI: 1.645–734.221; p = 0.023) and higher follow-up mortality (HR = 12.530; CI: 1.786 – 87.922; p = 0.011). Kaplan–Meier analysis demonstrated significantly reduced survival in the MSCI group (log-rank p = 0.011), with survival differences emerging early and persisting over follow-up.
Conclusions: Preoperative MSCI is an independent predictor of short-term mortality and delayed recovery following aortic arch surgery. Routine MoCA screening may improve risk stratification and support individualized perioperative care.
Authors
Xuyang Chen (1), Xiaogang Sun (2)
Institutions
(1) N/A, Beijing, Beijing, (2) Fuwai Hospital, Beijing, Xicheng Distric
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Poster Presenter
Xuyang Chen
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Beijing, Beijing
China
Objective: To evaluate whether immediate postoperative prophylactic cerebrospinal fluid (CSF) drainage outperforms preoperative timing in reducing spinal cord ischemia (SCI) and stroke risk in propensity score-matched (PSM) open thoracoabdominal aortic replacement (OTAAR) patients, addressing the evidence gap in balanced cohorts distinct from salvage strategies.
Methods: This retrospective PSM cohort study evaluated 727 OTAAR patients at a single high-volume center (January 2009–December 2024). Prophylactic CSF drainage groups were stratified as preoperative or immediate postoperative (within 1-hour post-closure), excluding salvage cases, pregnancies, simple thoracic/abdominal aortic replacements, inflammatory, or infectious aneurysms. After exclusions, 647 patients were included (96 no-drainage, 415 preoperative, 136 postoperative). PSM (1:1 nearest-neighbor matching, caliper 0.1) balanced covariates. Multivariable logistic regression assessed SCI predictors, and Cox proportional hazards modeled long-term all-cause mortality. Kaplan-Meier (KM) curves with log-rank tests evaluated survival.
Results: Overall, CSF drainage significantly reduced SCI incidence (no-drainage group: 11.5%, preoperative group: 7.7%, immediate postoperative group: 2.9%, P=0.041). In the drainage cohort, 120 matched pairs (N=240) achieved balanced baseline characteristics. SCI rates trended lower in the immediate postoperative group (3.3% vs 7.5%, P=0.254), with comparable inhospital mortality (5.0% vs 4.2%, P=1.000). Stroke incidence was significantly reduced (0% vs 6.7%, P=0.007). Multivariable logistic regression identified immediate postoperative drainage as an independent SCI protector (OR=0.22, 95% CI 0.07–0.72, P=0.013). Long-term survival showed no group differences (KM log-rank P=0.883), with multivariable Cox revealing advanced age as a mortality risk factor (HR=1.06, 95%CI 1.03-1.08, P<0.001) and hemoglobin as a protector (HR=0.98, 95%CI 0.97-0.99, P<0.001).
Conclusions: Prophylactic CSF drainage mitigates SCI risk in OTAAR. Immediate postoperative placement independently protects against SCI and reduces stroke incidence compared to preoperative timing, without survival differences. These findings support refined prophylactic drainage protocols to optimize neuroprotection in complex aortic surgery.
Authors
Bo Jia (1), Chengnan Li (2), Yipeng Ge (2), Haiou Hu (2), Zhiyu Qiao (2), JUNMING ZHU (3)
Institutions
(1) Beijing Anzhen Hospital Capital Medical University, Beijing, Beijing, (2) Beijing Anzhen Hospital of Capital Medical University, Beijing, NA, (3) N/A, BEIJING, China
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Poster Presenter
Bo Jia, Beijing Anzhen Hospital Capital Medical University
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Beijing, Beijing
China
Background: Diastolic dysfunction is common in patients with aortic stenosis (AS) and may influence short and long-term outcomes following surgical aortic valve replacement (sAVR). While assessment of diastolic function by echocardiography is challenging, AI ECG diastolic function assessment can be accurate and readily accessible. We hypothesized that AI-generated diastolic function grades based on perioperative ECGs strongly correlate with early and late outcomes following sAVR replacement.
Methods: We analyzed 5,503 patients undergoing isolated sAVR between 1993 and 2023. Diastolic function was assessed using a validated deep-learning AI model applied to 12-lead ECGs done preoperatively and on postoperative follow-up. Diastolic function grades were classified by AI into Grades 1 to 3. Longitudinal trend analyses and multivariable regression models were used to assess study endpoints.
Results: Among 5,503 patients (mean age 72.4 ± 10.8 yr; 39% female), more abnormal diastolic function, as indicated by higher AI-ECG diastolic function grades, was associated with greater comorbidity burden, including diabetes, renal disease, and heart failure. Compared to patients with AI-ECG diastolic function Grade 1, those with Grade 2 and 3 were at an independently higher risk of in-hospital mortality (OR 1.7, p=0.06; OR 2.5, p=0.007, respectively), prolonged mechanical ventilation (OR 1.4, p=0.016; OR 2.0, p<0.001), renal failure (OR 1.7, p=0.031; OR 2.4, p=0.002), and postoperative transfusion (OR 1.4, p<0.001; OR 1.5, p<0.001).
At 5-year follow-up, patients with Grade 3 diastolic function showed the least improvement in postoperative diastolic function (all p<0.001) (Figure 1A). Additionally, Grades 3 diastolic function at baseline was independently associated with the highest late mortality (HR 2.45; p < 0.001) (Figure 1B). Notably, lack of improvement in AI-ECG diastolic grade within the first year following surgery was independently associated with increased late mortality (HR 1.4, p<0.001) (Figure 1C)
Conclusion: Higher preoperative AI-ECG diastolic grades were associated with increased early postoperative complications, reduced long-term survival, and less favorable improvement in diastolic function over time. Lack of 1-year improvement in AI-ECG grade is also independently associated with increased late mortality following sAVR. Thus, assessment of diastolic function by AI-ECG offers a robust tool for risk stratification and monitoring of AS patients
Authors
Tedy Sawma (1), Hartzell Schaff, MD (2), Sina Danesh (2), Arman Arghami (3), Eunjung Lee (2), Masoomeh Aslahishahri (2), John Stulak (2), Kevin Greason (2), Joseph Dearani (4), Francisco Lopez-Jimenez (2), Paul Friedman (2), Sorin Pislaru (2), Itzhak Zachi
[email protected] (2), Jae Oh (2), Juan Crestanello (5)
Institutions
(1) Mayo Clinic - Rochester, Rochester, MN, (2) Mayo Clinic, Rochester, MN, (3) Mayo Clinic Hospitals Rochester, MN, Rochester, MN, (4) Mayo Clinic College of Medicine and Science, Rochester, MN, (5) Mayo Foundation, Rochester, MN
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Poster Presenter
Tedy Sawma, Mayo Clinic - Rochester
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Rochester, MN
United States
Objective: Endothelialization of cardiovascular conduits may be crucial for overcoming thrombogenic, haemodynamic, and degradative complications. Current paradigms emphasize transmural vessel ingrowth via pores as big as 50-80µm, yet biomaterial characterization often lacks the resolution to elucidate and quantify continuous, full thickness 3D pore architecture, leading to variable in vivo outcomes. This study establishes a novel, quantitative approach to non-destructively reconstruct conduit pore space, assess its 3D spatial porosity relevant to blood vessel permissivity, and validate findings in vivo.
Methods: Electrospun cardiovascular conduits were non-destructively scanned using micro-computed tomography (µCT) and processed with deep-learning super-resolution and segmentation to isolate the 3D pore phase. Pore network modelling (PNM) using a custom Python script reconstructed the pore space as an interconnected network, quantifying pore and throat dimensions. Scaffolds were implanted for 1 and 3 weeks in subcutaneous rodent model; explants were assessed for cell ingrowth, extracellular matrix maturation, and blood vessel density.
Results: Deep-learning-enhanced micro-computed tomography (µCT) enabled high-resolution (0.54 µm) imaging across large fields of view (2.8 mm²), achieving reconstructions exceeding 1 x 10⁸ µm³ in ≈70 minutes – a ≈57-fold increase in speed over a brute force approach, and ≈100-fold increase in volume compared to conventional methods like focused-ion beam scanning electron microscopy (FIB-SEM). Validation demonstrated improved accuracy in quantifying material metrics relative to confocal laser scanning microscopy (CLSM) and SEM. Pore network modelling (PNM) revealed median pore inscribed diameters of 5.51 µm (IQR: 5.15) for 16% polymer weight, 5.40 µm (IQR: 6.23) for 18%, and 5.40 µm (IQR: 4.22) for 20%. Thresholding revealed the highest density of interconnected, 3D ingrowth-permissive porosity within the 18% group, which translated at 3 weeks post-implantation, exhibiting collagen density comparable to controls and significantly increased vessel area versus 16% (p < 0.001) and 20% (p < 0.05).
Conclusions: Traditional characterization techniques may inadequately predict transmural blood vessel regeneration in cardiovascular conduits. This study demonstrates that µCT, deep learning, and PNM provide a reliable, efficient, and validated means to predict endothelial regeneration potential of implanted prostheses.
Authors
Andrea Tonelli (1), Timothy Pennel (1), Jaco Theron (1), Francesco Iacoviello (2), Peter Zilla (1)
Institutions
(1) Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa, (2) Correlative X-Ray Laboratory, University College of London, London, United Kingdom
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Poster Presenter
Andrea Tonelli, Groote Schuur Hospital, Observatory, Cape Town
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Cape Town
South Africa
Objective: The changes in regional left ventricular (LV) myocardial strain that follow septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) are not well defined. The LV regions that are typically involved and most frequently targeted during surgery are the basal anterior and mid-anterior septum, and the basal inferior free-wall. This study was designed to evaluate potential relationships between pre-and post-myectomy changes in segmental LV strain and postoperative mortality.
Methods: We retrospectively analyzed 187 HOCM patients who underwent speckle-tracking segmental strain analysis preoperatively and one year following septal myectomy. Logistic regression models adjusted for demographics, clinical risk factors, and systolic anterior motion of the mitral valve were used to assess segmental strain associations with postoperative mortality.
Results: The mean age was 56.9 ± 15.6 years. Baseline LV global longitudinal strain (LVGLS) was -18.6% (Q1-Q3: -20.3, -16.5), and LV ejection fraction was 66.3% (61.6, 72.7). At 1 year, GLS showed minimal overall change. Segment 3 (basal anteroseptal) improved slightly (+0.6 percentage points [pp], p=0.04) but was not independently associated with mortality. Preoperative segment 4 (basal inferoseptal) independently predicted higher postoperative mortality (OR 1.10 per 1-pp less negative strain, p=0.05)-approximately 10% higher risk per 1-pp worsening. Preoperative segment 12 (mid-anterolateral) was associated with improved survival (OR 0.90 per 1-pp more negative, p=0.05)-approximately 10% lower risk per 1-pp improvement. Postoperative segment 10 (mid-inferior) improvement was associated with lower mortality (OR 0.71 per 1-pp more negative, p=0.05)- approximately 29% lower risk per 1-pp improvement (Figure1).
Conclusions: Preoperative and post-myectomy segmental LV strain analysis identifies prognostically significant regions, particularly the basal inferior septal segment 4. Improved strain in this LV segment post-myectomy markedly reduces mortality risk. Targeted monitoring of segment-specific LV strain provides valuable prognostic insight and preoperative risk stratification and postoperative management strategies for HOCM patients undergoing septal myectomy.
Authors
Olga Kislitsina (1), Lubna Choudhury (1), Kifah Hussain (1), Bonnie Kane (1), James Thomas (1), Abigail Baldridge (1), Seokyung An (1), Jane Kruse (2), James Cox (1), Patrick McCarthy (1), Douglas Johnston (1)
Institutions
(1) Northwestern University, Chicago, IL, (2) Northwestern Medicine, Chicago, IL
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Poster Presenter
Olga Kislitsina, Northwestern University Feinberg School of Medicine
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Chicago, IL
United States
Objective: We evaluated the influence of perioperative anemia on sex-stratified outcomes following open thoracoabdominal aortic aneurysm repair (TAAAr).
Methods: This was a retrospective analysis conducted at a tertiary aortic center. All consecutive TAAArs from July 1997 to February 2025 were included. The primary outcome was a composite of in-hospital major adverse events (MAEs), including operative mortality, myocardial infarction (MI), cerebrovascular accident (CVA), postoperative bleeding requiring surgical revision, severe pulmonary dysfunction (tracheostomy or acute respiratory distress syndrome) and new need for dialysis. Causal mediation analysis was performed to quantify the extent to which perioperative anemia accounts for the effect of sex on the risk of MAEs.
Results: This analysis consisted of 780 TAAArs, 40% (312/780) of which were female. Females were older (median 71 years [Interquartile Range (IQR) 63, 77] vs. 64 years [IQR 55, 73], p<0.001), with increased chronic obstructive pulmonary disease (49% [153/312] vs. 38% [177/468], p=0.002) and peripheral vascular disease (31% [96/312] vs. 20% [95/468], p<0.001). Extent distribution was similar between cohorts. Females had lower preoperative hemoglobin (g/dL) (median 11.5 [IQR 10.4, 12.5] vs. 12.5 [IQR 11.0, 13.8] p<0.001) and hematocrit (%) (median 34.5 [IQR 31.7, 37.9] vs. 37.6 [IQR 33.3, 41.0] p<0.001) and lower intraoperative hemoglobin (g/dL) (median 7.5 [IQR 6.8, 8.4] vs. 8.0 [IQR 7.1, 9.0] p<0.001) and hematocrit (%) (median 22.0 [IQR 20.0, 25.0] vs. 23.0 [IQR 21.0, 26.0] p<0.001) nadirs. Females were more likely to experience MAEs than males (24% [74/312] vs. 18% [84/468], p=0.05). On causal analysis, female sex was associated with a 5.9% (Estimate 0.059 95% Confidence Interval [CI]: 0.007-0.112, p=0.02) higher probability of MAE when compared to male sex. Of this total effect, 2.2% (Estimate 0.022 95% CI: 0.011-0.033, p<0.001) was indirectly mediated through lower intraoperative hematocrit nadir. Overall, 36.4% (Estimate 0.364 95% CI 0.100-2.345, p=0.02) of the total causal effect of female sex on the probability of MAE was mediated through differences in intraoperative hematocrit nadir.
Conclusion: Differences in intraoperative anemia are a potent mediator of postoperative mortality and morbidity in females, suggesting a modifiable mechanism for mitigating sex differences in TAAAr outcomes.
Authors
Alexander Gregg (1), Katherine Krieger (1), Arnar Ingason (1), Bjorn Redfors (1), Jessica Kim (1), Rachel Heise (1), Francesca Pisano (1), Nathnael Feleke (1), Shamha Shiyam (1), Darin Mak (1), Ezra Shimabenga (1), Andrew Kuzemczak (1), Kwadwo Amoako-Boadu (1), Giovanni Jr Soletti (1), Charles Mack (1), Eilon Ram (1), Christopher Lau (1), Mario Gaudino (1), Leonard Girardi (1)
Institutions
(1) Weill Cornell Medicine, New York, NY
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Poster Presenter
Alexander Gregg, NYP|Weill Cornell Medicine
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New York, NY
United States
Objective: The PETTICOAT technique has been used in the treatment of complicated TBAD. Recently this technique has also been applied to the residual persistent false lumen (FL) of the post-operative TAAD. However, recent studies have shown that the PETTICOAT technique alone may fail to induce thrombosis of the abdominal aortic FL. Because in Japan abdominal aortic branch devices are not covered by insurance, we applied the FL occlusion procedures to accomplish complete FL thrombosis. This study objective was to evaluate the clinical outcomes of this procedures.
Methods: From October 2015 to December 2024, we performed the PETTICOAT technique in 158 nonconsecutive patients (TBAD 83, post operative TAAD 75), of which 83 patients' consent was obtained to apply FL occlusion procedures. All the ancillary procedures were planned based on the computed tomography imaging and done in a stepped approach to avoid spinal cord ischemia. The FL occlusion procedures consist of the way hereinafter prescribed. When the branch artery is dissected with a distal re-entry or avulsed, a peripheral stent graft is deployed through the interstices of the aortic bare metal stent across the distal re-entry or the detached ostium. When there is no branch around the re-entry, the re-entry is simply occluded by an aortic or peripheral stent graft with or without FL coil embolization.
Results: Total 83 cases (TBAD 37/ postoperative TAAD 46: AAR 27/ PAR 1/ TAR 7/ TAR+FET 6/ Bentall 4/ Bentall+TAR+CET 1), 66 men, average age was 59.5 years. The average duration from the onset to PETTICOAT procedure was 363 days (0-5730) and from the PETTICOAT technique to the 1st re-intervention was 4.0 months (1-21). The average re-intervention was 1.86 times (1-4), and No complications were found. Complete FL thrombosis was observed in 57 cases and consequently aorta was completely remodeled in 41 cases. In cases with incomplete FL thrombosis, open conversion was observed in one case, and minor FL flow in the thoracoabdominal region remains in the remaining cases. The false lumen complete thrombosis/aortic remodeling rates by intervention timing after dissection onset were as follows: acute phase (up to 2 weeks: 7 cases) 7/6, subacute phase (2 weeks to 3 months: 31 cases) 25/22, and chronic phase (3 months or longer: 45 cases) 25/13.
Conclusion: Although longer follow-up results are needed, our FL occlusion procedures may be the simplest and relatively easy procedure to induce FL thrombosis.
Authors
Masatoshi Komooka (1), Shinichi Higashiue (2), Satoshi Kuroyanagi (3), Onichi Furuya (4), Saburo Kojima (1), Kensuke Kasuga (1), Masaaki Kobayashi (3), Motonari Shimizu (5)
Institutions
(1) Yao Tokushukai General Hospital, Yao, Osaka, Japan, (2) Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan, (3) Kishiwada Tokushukai hospital, Kishiwada, Osaka, Japan, (4) Kishiwada Tokushukai hospital, Kishiwada, Osaka Japan, (5) Yao Tokushukai General Hospital, Yao, Osaka
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Poster Presenter
Masatoshi Komooka, Kishiwada City Hospital
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Osaka
Japan
Objective: Despite advancements in technical and perioperative care, surgery for acute type A aortic dissection (ATAAD) carries significant morbidity and mortality. Prior studies have demonstrated that center volume influences outcomes. This study evaluates whether high-volume aortic surgeons independently improve perioperative and long-term outcomes compared to their low-volume counterparts.
Methods: Patients with acute type A aortic dissection from 2011–2024 were identified. Patients younger than eighteen years old, and with prior aortic intervention were excluded. A high-volume surgeon was considered one who performed surgery on more than 10 patients a year with ATAAD. Patients were stratified based on the operating surgeon performing their surgery – high versus low volume aortic surgeons. Endpoints included operative and long-term mortality apart from postoperative outcomes.
Results: A total of 705 patients underwent ATAAD repair; 635 (90.1%) were operated on by high-volume surgeons and 70 (9.9%) by low-volume surgeons. Preoperative demographics were similar, although patients operated on by low-volume surgeons had lower rates of malperfusion (9.9% vs 17.4% p=0.024), lower prevalence of peripheral vascular disease (22.5% vs. 38.1%, p=0.01) and less likely to have previous cardiac surgery (5.6% vs. 14.4%, p=0.04). High-volume surgeons performed significantly more aortic root reconstructions (64.1% vs. 43.7%, p=0.001 and frozen elephant trunk procedures (10.6% vs 4.2% p=0.08). High-volume surgeons were associated with lower 30-day mortality (12.5% vs. 22.5%, p=0.017), fewer reoperations for bleeding (16.5% vs. 26.8%, p=0.03), and reduced ICU hours (median 69.3 vs. 112, p<0.001). No significant differences were observed in five-year survival (71.8% vs. 74.9%, p=0.567) or postoperative stroke. However, Kaplan–Meier survival analysis showed that patients operated by a high-volume surgeon had superior overall survival (log-rank, p = 0.04). Multivariable regression demonstrated that age, dialysis, hypertension, and frozen elephant trunk procedures were predictors of mortality.
Conclusions: High-volume surgeons were associated with superior early outcomes in ATAAD repair, including lower operative mortality, reoperation for bleeding, and ICU utilization, despite performing more complex procedures. These findings may support prioritizing surgeon-specific experience in care pathways for surgery for acute type A aortic dissection.
Authors
MANUEL GIRALDO GRUESO (1), Aryan Meknat (2), Derek Serna-Gallegos (3), Irsa Hasan (4), Takuya Ogami (3), Johannes Bonatti (1), David Kaczorowski (5), Danny Chu (3), Ibrahim Sultan (3)
Institutions
(1) UPMC Presbyterian, Pittsburgh, PA, (2) Allegheny Health Network, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) University of Pittsburgh Medical Center, Pittsburg, PA, (5) University of Pittsburgh, Venetia, PA
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Poster Presenter
MANUEL GIRALDO GRUESO, UPMC Presbyterian
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Pittsburgh, PA
United States
Objective: Chronic thromboembolic pulmonary hypertension (CTEPH) results from incomplete resolution of acute pulmonary embolism. Three treatment modalities are now available, Pulmonary Endarterectomy (PTE/PEA) surgery, with Balloon Pulmonary Angioplasty (BPA) and approved drug therapy for inoperable patients. The second international CTEPH registry aimed to investigate CTEPH management internationally and represents the largest PTE registry experience. PTE results were assessed and compared with the first European registry, reported in 2011, before the era when BPA and licenced drug therapy were available.
Methods: Consecutive incident patients with CTEPH were recruited into the registry between February 2015 and September 2016, with follow up to September 2019 from 34 participating international centres in 20 countries.
Results: One thousand and nine patients were recruited and 605 (60%) underwent PTE surgery at 29 centres, compared with 57% in the first registry, with a higher utilisation in Europe and the USA compared with other areas. BPA was utilised in 185 (18%) patients and 219 (22%) patients underwent no mechanical therapy. The median age of surgical patients was 60 [49,70] years and 53% were male; the time between symptoms and diagnosis was 15 months, all unchanged from the first registry. The majority of patients (75%) were in functional classes III/IV, with a mean pulmonary artery pressure of 45 [36,51] mmHg and pulmonary vascular resistance (PVR) 646 [456,906] dyn.s.cm-5. PVR was reduced to 254 dyn.s.cm-5 (by 60%) following surgery. Mortality at 30 days was 2.4%, (0.8% for patients with PVR < 800 dyn.s.cm-5), which was less than the first registry (5.2 %). Survival at 1 year was 95%, compared with 92% in the first registry. The 4 centres performing > 50 operations per year had the lowest 30-day mortality (2%), least ECMO use (3%), and highest 1 year survival 97%. Survival to 5 years, compared with the other modalities of treatment, is shown in figure 1.
Conclusions: In the second international CTEPH registry, despite the availability of two new treatments, PTE remains the most common treatment for CTEPH with improved outcomes, low operative mortality and excellent medium-term survival.
Authors
David Jenkins (1), Elie Fadel (2), Christoph B. Wiedenroth (3), Eckhard Mayer (3), Andrea D''Armini (4), bedrettin yildizeli (5), Marion Delcroix (6), Nick H. Kim (7), Hiromi Matsubara (8), Irene Lang (9), Joanna Pepke-Zaba (1), Gerald Simonneau (10), Aruna Bansal (11), Michael Madani (12)
Institutions
(1) Royal Papworth Hospital, Cambridge, UK, (2) Marie Lannelongue Hospital, Paris, France, (3) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, (4) University of Pavia, Pavia, Italy, (5) Marmara University,, Istanbul, Turkey, (6) University Hospitals Leuven, Leuven, Belgium, (7) UC San Diego Health, La Jolia, CA, (8) Okayama Medical center, Okayama, Japan, (9) Medical University of Vienna, Vienna, Austria, (10) Universite Paris-Sud, Paris, France, (11) Acclarogen Ltd, Cambridge, UK, (12) UC San Diego Health, La Jolla, CA
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Poster Presenter
*David Jenkins, Royal Papworth Hospital
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Cambridge, UK
United Kingdom