P107. Do Collagen Impregnated Frozen Elephant Trunk Stent Grafts Bleed Less Than Non-Collagen Impregnated Grafts?
Royal Papworth Hospital
CAMBRIDGE, Cambridgeshire
United Kingdom - Contact Me
Mr De Silva qualified from the medical school of St Bartholomew's Hospital, London, in 1996. After completing junior surgical training his interest in cardiac surgery was piqued at the Royal Brompton Hospital where he worked for Professor Sir Magdi Yacoub amongst others. There followed a 2 year period of research into the inflammatory effects of cardiopulmonary bypass, under the mentorship of Professors Dunning and Wallwork at the Royal Papworth hospital, after which he began a six year cardiac surgical training programme at Royal Papworth.
Subsequently he had a brief stint as a consultant at the Heart Hospital London, followed by 4 years at the Oxford Heart Centre working alongside Professor Westaby. He retruned to Royal Papworth in 2014 and since 2019 has lead the aortic surgery programme. Royal Papworth has the largest experience of aortic arch surgery in the UK, and a thriving aortic valve repair and valve sparing aortic root programmes, all of which he leads.
He is the proud father of two girls, and enjoys clycling and running in his spare time.
Description
Ravi J De Silva, Shiu Chung Tam, Martin Muir, Aravinda Page, Ismail Vokshi, Fouad J Taghavi, Shakil Farid, Florian Falter
Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
Objectives
Aortic arch surgery is complex and prone to bleeding. There are several manufacturers of stent-graft prostheses which are used to perform a frozen elephant trunk (FET) procedure. The greatest international experience is with a collagen impregnated vascular graft attached to a nitinol reinforced stent (FET-C). A similar prosthesis with some unique features has been introduced which has a non-collagen impregnated vascular graft (FET-NC). Anecdotal experiences report these new grafts to be more porous and prone to bleed, presumably due to a lack of the collagen in the vascular graft. We reviewed our experience of these two prostheses to better understand if collagen impregnation of the vascular graft has any impact on post-operative bleeding or transfusion requirements.
Methods
We have performed more than 200 FET operations, but retrospectively reviewed our last 50 consecutive FET procedures including emergency cases. This case series included the introduction of the newer non-collagen impregnated graft (FET-NC). Electronic medical records were used to ascertain patient demographic and operative details, post operative bleeding and transfusion requirements.
Results
Of the last 50 consecutive frozen elephant trunk procedures, 33 used the FET-C prosthesis (table 1). 22 of these were elective, 7 were redo cardiac, and 7 needed additional concomitant cardiac surgery. Of the 17 FET-NC cases, 13 were elective, 3 redo cardiac, and 2 required additional concomitant cardiac surgery. There was no statistical difference in age (FET-C 70.5 years, FET-NS 74.0 years, p=0.07) and sex (FET-C 52% male, FET-NC 57% male, p=0.51) of the two groups. There was no difference in cardiopulmonary bypass time (FET-C 243', FET-NC 198', p=0.33) or lower body ischemic time (FET-C 35', FET-NC 28', p=0.28). All patients were cooled to a core temperature of 250C.
Average chest drain output after 24 hours was similar in both groups (FET-C 550ml, FET-NC 552 ml, p=0.43). There was no statistical difference in average chest tube drainage in the second 24 hours after surgery (FET-C 450ml, FET-NC 425ml, p=0.60).
With respect to post operative transfusion requirements there was no difference in average requirement for packed red blood cells (FET-C 5 units, FET-NC 6 units, p=0.27), fresh frozen plasma (FET-C 4 units, FET-NC 4 units, p=0.98), platelets (FET-C 2 units, FET-NC 2 units, p=0.31) or cryoprecipitate (FET-C 1 unit, FET-NC 2 units, p=0.40).
Conclusions
In our series of 50 consecutive cases, we find no evidence to suggest non-collagen impregnated frozen elephant trunk prostheses are more likely to bleed or require increased post-operative transfusion.
Authors
RAVI DE SILVA (1), Shiu Tam (1), Martin Muir (1), Aravinda Page (1), Ismail Vokshi (1), Fouad Taghavi (1), Shakil Farid (1), Florian Falter (1)
Institutions
(1) Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire