P326. Temporal Trends in Aortic Valve Surgery: Preserving the Valve
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz
Denver, CO
United States - Contact Me
Adam Carroll is a current PGY-3 surgical resident at the University of Colorado. Adam attended medical school at the University of Colorado and has been involved in research with the cardiothoracic surgery department throughout medical school and residency. He has interest specifically in endovascular and transcatheter aortic interventions, as well as neurologic outcomes in aortic research. He is currently in the aortic surgery research labaratory in the Department of Cardiothoracic Surgery at the University of Colorado. He plans to pursue a career in cardiothoracic surgery following his general surgery residency.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective
With the approval of TAVR for low-risk patients, surgical aortic valve replacement (AVR) has become primarily used for patients with bicuspid aortic valve disease, especially for younger patients given the limited durability of bioprosthetic TAVR valves. However, for younger patients, the need for lifelong anticoagulation after mechanical AVR places a significant burden on patients with increased risk of bleeding events. As data has emerged regarding the durability of ring annuloplasty, particularly in bicuspid aortic valve patients, our institution has adopted their use not just in bicuspid aortic valve patients, but also in patients without aberrant valve anatomy with increased surgeon experience. We sought to evaluate institutional temporal trends in AVR versus aortic valve repair (AVr), including the frequency of valve replacement in root replacement, and the trends in usage of ring annuloplasty.
Methods
Using our prospectively maintained institutional database, we identified patients who underwent aortic valve repair or replacement from 2016-2023 and whether any adjunct root replacement procedure was performed. Furthermore, we analyzed temporal trends annually in repair versus replacement and in valve sparing versus non-valve sparing root replacement. We looked at four-year trends (2016-2019 and 2020-2023) for repair versus replacement in bicuspid aortic valve (BAV) patients and in ring annuloplasty utilization in AVr.
Results
529 patients were identified who underwent aortic valve repair or replacement from 2016-2023, with 183 (34.6%) undergoing AVr, and 346 (65.4%) undergoing AVR. Among these patients, 295 (55.8%) had an adjunctive root replacement procedure. Annually, there was a significant increasing trend toward aortic valve repair (p<0.001), and a trend toward valve-sparing root replacement (p=0.009). Regarding four-year trends, there was a significant increase in the utilization of ring annuloplasty (p<0.001), and a significant increase in aortic valve repairs in BAV patients (p= 0.027). Prior to 2020, only 54 aortic valve repairs were performed, with a large increasing following.
Conclusions
A significant institutional trend in performing aortic valve repair and in preserving the aortic root was seen across an 8-year trend at our institution. Our data suggested that at least 50 aortic valve repairs, which can be more challenging to ensure a durable repair, particularly in bicuspid patients, are required to ensure adequate comfort in performing the procedure routinely. Thus, we advocate for the performance of aortic valve repairs at experienced centers.
Authors
Adam Carroll (1), Michael Kirsch (1), Jessica Rove (1), John Iguidbashian (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
With the approval of TAVR for low-risk patients, surgical aortic valve replacement (AVR) has become primarily used for patients with bicuspid aortic valve disease, especially for younger patients given the limited durability of bioprosthetic TAVR valves. However, for younger patients, the need for lifelong anticoagulation after mechanical AVR places a significant burden on patients with increased risk of bleeding events. As data has emerged regarding the durability of ring annuloplasty, particularly in bicuspid aortic valve patients, our institution has adopted their use not just in bicuspid aortic valve patients, but also in patients without aberrant valve anatomy with increased surgeon experience. We sought to evaluate institutional temporal trends in AVR versus aortic valve repair (AVr), including the frequency of valve replacement in root replacement, and the trends in usage of ring annuloplasty.
Methods
Using our prospectively maintained institutional database, we identified patients who underwent aortic valve repair or replacement from 2016-2023 and whether any adjunct root replacement procedure was performed. Furthermore, we analyzed temporal trends annually in repair versus replacement and in valve sparing versus non-valve sparing root replacement. We looked at four-year trends (2016-2019 and 2020-2023) for repair versus replacement in bicuspid aortic valve (BAV) patients and in ring annuloplasty utilization in AVr.
Results
529 patients were identified who underwent aortic valve repair or replacement from 2016-2023, with 183 (34.6%) undergoing AVr, and 346 (65.4%) undergoing AVR. Among these patients, 295 (55.8%) had an adjunctive root replacement procedure. Annually, there was a significant increasing trend toward aortic valve repair (p<0.001), and a trend toward valve-sparing root replacement (p=0.009). Regarding four-year trends, there was a significant increase in the utilization of ring annuloplasty (p<0.001), and a significant increase in aortic valve repairs in BAV patients (p= 0.027). Prior to 2020, only 54 aortic valve repairs were performed, with a large increasing following.
Conclusions
A significant institutional trend in performing aortic valve repair and in preserving the aortic root was seen across an 8-year trend at our institution. Our data suggested that at least 50 aortic valve repairs, which can be more challenging to ensure a durable repair, particularly in bicuspid patients, are required to ensure adequate comfort in performing the procedure routinely. Thus, we advocate for the performance of aortic valve repairs at experienced centers.
Authors
Adam Carroll (1), Michael Kirsch (1), Jessica Rove (1), John Iguidbashian (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
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.