P047. Aortic Root Reconstruction Provides Satisfactory Outcomes in Patients With Acute Type A Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Memorial Hermann Heart and Vascular Institute
Houston, TX
United States - Contact Me
Cardiovascular surgeon at Memorial Hermann Hospital and McGovern Medical School at UTHealth
Integrated vascular surgery residency 2017-2022
Aortic & Structural Heart Fellowship 2015-2017
Board-certified for Japanese cardiovascular surgery and general surgery
Board-certified for Vascular Surgery in US
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective:
Aortic root replacement (ARR) is performed in 20-30% of patients who present with acute type A aortic dissection in many aortic centers. We reviewed our two-decade experience to evaluate for the results of root conservation approach in acute type A aortic dissection ATAD.
Methods:
All open ATAD repairs performed at our institution from December 1999 to December 2023 were reviewed. Perioperative data were reviewed and patients who did not have ARR was compared with ARR.
Results:
Total of 770 patients had type A aortic repair during the study period. 75 (9%) patients had ARR, and modiced Bentall was the most common procedure (63%). Patients with ARR were younger (43 yo vs. 59 yo, P<0.001), more commonly male (87% vs. 69%, P<0.001), had hereditary thoracic aortic disease (53% vs. 6%, <0.0001), and had fewer comorbidities (COPD, CKD Stage greater than 3b, diabetes, coronary artery disease; all P<0.002). Median aortic root diameter prior to procedure was 40(IQR 36-44)mm in non-ARR group while that of ARR group was 54(IQR 48-65)mm. Aortic clamp time (95min vs 151min, P<0.001) and cardiopulmonary bypass time (150min vs. 198min, P<0.001) were shorter in non-ARR group but circulatory arrest time were longer (27min vs. 20min, P<0.001). Operative mortality was similar in 2 groups (non-ARR 13% vs. ARR 14%, P<0.804). Re-exploration for bleeding was significantly less in non-ARR (3% vs. 11%, P<0.008). In non-ARR group, 9 patients developed severe aortic insuhciency during follow-up and 12 patients had dilation of aortic root >50mm (of 12, 6 had severe AI) All the 9 severe AI underwent proximal re-intervention. There were 8 patients who did not have severe AI underwent proximal intervention at the time of redo total arch replacement with elephant trunk to prepare for distal intervention. There was no aortic root rupture. Reintervention-free survival was similar in 2 groups (10-year, non-ARR 52.2% ± 3.3% vs. ARR 59.1% ± 10.6% vs.).
Conclusions:
Patients without ARR were older and had more comorbidities. In acute type A aortic
dissection, aortic root conservation may be performed with reasonable early and late result.
Authors
Yuki Ikeno (1), Akiko Tanaka (1), Alexander Mills (1), Lucas Ribe (1), Harleen Sandhu (1), Charles Miller (1), VIACHESLAV BOBOVNIKOV (1), steven eisenberg (1), Anthony Estrera (1)
Institutions
(1) McGovern Medical School at UTHealth, Houston, TX
Aortic root replacement (ARR) is performed in 20-30% of patients who present with acute type A aortic dissection in many aortic centers. We reviewed our two-decade experience to evaluate for the results of root conservation approach in acute type A aortic dissection ATAD.
Methods:
All open ATAD repairs performed at our institution from December 1999 to December 2023 were reviewed. Perioperative data were reviewed and patients who did not have ARR was compared with ARR.
Results:
Total of 770 patients had type A aortic repair during the study period. 75 (9%) patients had ARR, and modiced Bentall was the most common procedure (63%). Patients with ARR were younger (43 yo vs. 59 yo, P<0.001), more commonly male (87% vs. 69%, P<0.001), had hereditary thoracic aortic disease (53% vs. 6%, <0.0001), and had fewer comorbidities (COPD, CKD Stage greater than 3b, diabetes, coronary artery disease; all P<0.002). Median aortic root diameter prior to procedure was 40(IQR 36-44)mm in non-ARR group while that of ARR group was 54(IQR 48-65)mm. Aortic clamp time (95min vs 151min, P<0.001) and cardiopulmonary bypass time (150min vs. 198min, P<0.001) were shorter in non-ARR group but circulatory arrest time were longer (27min vs. 20min, P<0.001). Operative mortality was similar in 2 groups (non-ARR 13% vs. ARR 14%, P<0.804). Re-exploration for bleeding was significantly less in non-ARR (3% vs. 11%, P<0.008). In non-ARR group, 9 patients developed severe aortic insuhciency during follow-up and 12 patients had dilation of aortic root >50mm (of 12, 6 had severe AI) All the 9 severe AI underwent proximal re-intervention. There were 8 patients who did not have severe AI underwent proximal intervention at the time of redo total arch replacement with elephant trunk to prepare for distal intervention. There was no aortic root rupture. Reintervention-free survival was similar in 2 groups (10-year, non-ARR 52.2% ± 3.3% vs. ARR 59.1% ± 10.6% vs.).
Conclusions:
Patients without ARR were older and had more comorbidities. In acute type A aortic
dissection, aortic root conservation may be performed with reasonable early and late result.
Authors
Yuki Ikeno (1), Akiko Tanaka (1), Alexander Mills (1), Lucas Ribe (1), Harleen Sandhu (1), Charles Miller (1), VIACHESLAV BOBOVNIKOV (1), steven eisenberg (1), Anthony Estrera (1)
Institutions
(1) McGovern Medical School at UTHealth, Houston, TX
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.