P379. Valve-Sparing Root Replacement: How Old is Too Old?
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Emory University School of Medicine
Atlanta, GA
United States - Contact Me
Elizabeth Norton, MD is an integrated cardiothoracic surgery resident at Emory University.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Valve-sparing root replacement (VSRR) has been shown to have excellent short- and long-term outcomes and is performed in a wide range of age into the 8th decade of life, although more often in young patients. The specific clinical factors that limit the advantages of a VSRR; however, has been understudied. This study analyzed the impact of age and preoperative comorbidities on reoperation and survival following VSRR.
Methods: From 2004-2021, in an academic database, 780 patients underwent VSRR. VSRR was performed using the David V reimplantation technique. The majority of VSRRs were performed with tailored straight tube grafts or Gelweave Valsalva graft. A discriminating age cut-off for the effect of age was determined by Contal and O'Quigley methods and patients were then divided into two groups based on age at time of surgery. Median follow-up time was 7.1 (3.3, 10.5) years with a follow-up index of 0.84.
Results: The optimal cut-off for age among patients undergoing VSRR was found to be 65 years. Sixteen percent of patients undergoing VSRR were ≥65 years at time of surgery. Overall, in-hospital mortality was 1.5% [12/780] and significantly higher among the ≥65 group (4.1% [5/123]vs 1.1% [7/657], p=0.03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between ≥65 and <65 groups (5% [95% CI: 2%, 10%] vs 6% [95% CI: 4%, 9%] p=0.28) and reoperative indications were similar between groups. Recurrence of moderate-severe aortic insufficiency was similar between ≥65 and <65 groups (14% [15/106] vs 11% [61/564], p=0.32). Overall, 10-year survival was 89% [95% CI: 85%, 91%] and significantly worse among the ≥65 group (76% [95% CI: 66%, 83%] vs 92% [95% CI: 88%, 94%], p<0.0001). Age ≥65 was an independent risk factor for late mortality (HR=5.28 [95% CI: 2.17, 12.8], p<0.001) as was longer cardiopulmonary bypass times (HR=1.01 [95% CI: 1.00, 1.02], p=0.04) and postoperative acute renal failure (HR=7.99 [95% CI: 2.24, 28.5], p<0.01).
Conclusion: Valve-sparing root replacement can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients ≥65 years old, however, aortic root replacement using a composite valve-graft conduit (ie: Bentall) should be considered due to the complexity of VSRR operations as well as worse short- and long-term survival outcomes.
Authors
Elizabeth Norton (1), Yanhua Wang (1), Parth Patel (1), Dov Levine (2), Jose Binongo (3), Bradley Leshnower (4), Hiroo Takayama (5), Edward Chen (6)
Institutions
(1) Emory University, Atlanta, GA, (2) Columbia University, New York, NY, (3) Emory Rollins School of Public Health, Atlanta, GA, (4) Emory University Hospital, Atlanta, GA, (5) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (6) Duke University Medical Center, Durham, NC
Methods: From 2004-2021, in an academic database, 780 patients underwent VSRR. VSRR was performed using the David V reimplantation technique. The majority of VSRRs were performed with tailored straight tube grafts or Gelweave Valsalva graft. A discriminating age cut-off for the effect of age was determined by Contal and O'Quigley methods and patients were then divided into two groups based on age at time of surgery. Median follow-up time was 7.1 (3.3, 10.5) years with a follow-up index of 0.84.
Results: The optimal cut-off for age among patients undergoing VSRR was found to be 65 years. Sixteen percent of patients undergoing VSRR were ≥65 years at time of surgery. Overall, in-hospital mortality was 1.5% [12/780] and significantly higher among the ≥65 group (4.1% [5/123]vs 1.1% [7/657], p=0.03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between ≥65 and <65 groups (5% [95% CI: 2%, 10%] vs 6% [95% CI: 4%, 9%] p=0.28) and reoperative indications were similar between groups. Recurrence of moderate-severe aortic insufficiency was similar between ≥65 and <65 groups (14% [15/106] vs 11% [61/564], p=0.32). Overall, 10-year survival was 89% [95% CI: 85%, 91%] and significantly worse among the ≥65 group (76% [95% CI: 66%, 83%] vs 92% [95% CI: 88%, 94%], p<0.0001). Age ≥65 was an independent risk factor for late mortality (HR=5.28 [95% CI: 2.17, 12.8], p<0.001) as was longer cardiopulmonary bypass times (HR=1.01 [95% CI: 1.00, 1.02], p=0.04) and postoperative acute renal failure (HR=7.99 [95% CI: 2.24, 28.5], p<0.01).
Conclusion: Valve-sparing root replacement can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients ≥65 years old, however, aortic root replacement using a composite valve-graft conduit (ie: Bentall) should be considered due to the complexity of VSRR operations as well as worse short- and long-term survival outcomes.
Authors
Elizabeth Norton (1), Yanhua Wang (1), Parth Patel (1), Dov Levine (2), Jose Binongo (3), Bradley Leshnower (4), Hiroo Takayama (5), Edward Chen (6)
Institutions
(1) Emory University, Atlanta, GA, (2) Columbia University, New York, NY, (3) Emory Rollins School of Public Health, Atlanta, GA, (4) Emory University Hospital, Atlanta, GA, (5) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (6) Duke University Medical Center, Durham, NC
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.