P272. Pulmonary Artery Injury is Inconsequential in Re-do Aortic Arch Surgery
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: Re-intervention of the aorta poses a technical challenge and risk of iatrogenic injury to surrounding structures due to significant scar tissue. The pulmonary arteries (PA) are at particular risk for injury, especially in distal ascending interventions. We hypothesize that when a PA injury does occur, if recognized and repaired at the time of surgery, patients are not at risk for adverse postoperative outcomes.
Methods: All patients who underwent re-do sternotomy for aortic arch or root intervention in our single institution prospectively maintained database between February 2010 and December 2023 were reviewed. In total, 238 patients were identified for analysis. Patients were stratified into two cohorts based on whether PA injury occurred. Pre-, intra- and post-operative outcomes were analyzed.
Results: Of the 238 patients who underwent re-do sternotomy for aortic intervention, 34 (14.3%) required PA repair and 204 (85.7%) did not require PA repair. Patients who underwent PA repair were more likely to undergo more extensive aortic intervention (p<0.001), with the majority occurring in total arch replacement (70.6%). Notably, patients who required PA repair had significantly longer cardiopulmonary bypass time (p<0.001), cross clamp time (p=0.014) and circulatory arrest time (p<0.001). When separated by procedure type, significant differences remained in total arch cardiopulmonary bypass time and cross-clamp time, but not with circulatory arrest time. No significant difference was present in any of the three times for hemiarch repair, however, the total number of PA injuries in hemiarch was small (N=7). PA injury was associated with greater administration of intra-operative FFP, but not other blood products. PA injury was not associated with any significant difference in post-operative outcomes, including risk of open chest or take back for bleeding, blood product transfusion, hospital or ICU length of stay, and post operative morbidity or mortality.
Conclusions: PA injury in re-do sternotomy is a common injury, that is more likely to occur with more extensive & complex aortic reinterventions. PA injury is significantly associated with longer cardiopulmonary bypass times and aortic cross clamp times in total arches, but not hemiarches, likely reflective of the more extensive tissue dissection required in total arches. However, when PA injury occurs and is recognized it does not increase the risk of post-operative morbidity or mortality.
Authors
Adam Carroll (1), Nicolas Chanes (1), Ananya Shah (1), Zihan Feng (1), Michal Schafer (1), Kelly Higa (1), Jintong Liu (1), Jacob Edwards (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Methods: All patients who underwent re-do sternotomy for aortic arch or root intervention in our single institution prospectively maintained database between February 2010 and December 2023 were reviewed. In total, 238 patients were identified for analysis. Patients were stratified into two cohorts based on whether PA injury occurred. Pre-, intra- and post-operative outcomes were analyzed.
Results: Of the 238 patients who underwent re-do sternotomy for aortic intervention, 34 (14.3%) required PA repair and 204 (85.7%) did not require PA repair. Patients who underwent PA repair were more likely to undergo more extensive aortic intervention (p<0.001), with the majority occurring in total arch replacement (70.6%). Notably, patients who required PA repair had significantly longer cardiopulmonary bypass time (p<0.001), cross clamp time (p=0.014) and circulatory arrest time (p<0.001). When separated by procedure type, significant differences remained in total arch cardiopulmonary bypass time and cross-clamp time, but not with circulatory arrest time. No significant difference was present in any of the three times for hemiarch repair, however, the total number of PA injuries in hemiarch was small (N=7). PA injury was associated with greater administration of intra-operative FFP, but not other blood products. PA injury was not associated with any significant difference in post-operative outcomes, including risk of open chest or take back for bleeding, blood product transfusion, hospital or ICU length of stay, and post operative morbidity or mortality.
Conclusions: PA injury in re-do sternotomy is a common injury, that is more likely to occur with more extensive & complex aortic reinterventions. PA injury is significantly associated with longer cardiopulmonary bypass times and aortic cross clamp times in total arches, but not hemiarches, likely reflective of the more extensive tissue dissection required in total arches. However, when PA injury occurs and is recognized it does not increase the risk of post-operative morbidity or mortality.
Authors
Adam Carroll (1), Nicolas Chanes (1), Ananya Shah (1), Zihan Feng (1), Michal Schafer (1), Kelly Higa (1), Jintong Liu (1), Jacob Edwards (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.