P003. 5-year Outcomes following Redo-aortic Surgeries: A Single Centre Experience
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Royal Papworth Hospital
Cambridge
United Kingdom - Contact Me
Oluwanifemi Akintoye is a Junior Clinical Fellow, currently working at Royal Papworth Hospital NHS Trust in Cambridge. She is interested in pursing a career in cardiothoracic surgery with interest in aortic disease. In her role, she has been invloved in the perioperative management of patients in the ward and in the cardiac ICU. She doubles as an education fellow in the trust where is involved with developing teaching programes and teaching undergraduate medical students from the Univeristy of Cambridge undergoing electives in the trust.
She has completed a Masters of Philosopy in Population Health Science from the Univeristy of Cambridge where she completed a research on anatomical factors affecting post-operative outcomes in aortic intervention. She is actively involved in research and has published papers in peer reviewed journals.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: The last few decades have seen a steady rise in incidence of reoperations in cardiac surgery, such that redo cardiac surgery has become an integral part of cardiac surgery. Redo aortic surgeries are complex procedures known to be associated with increased morbidity and mortality compared to primary aortic procedures. We aimed to report on the early outcomes and 5-year outcome following redo aortic surgeries in our centre.
Methods: Of the 348 patients who had redo-cardiac surgery in our centre from January 1st, 2018, to August 30th, 2023, 77 (22.1%) patients underwent redo aortic surgery and were included in this study. The primary outcome of interest was in-hospital mortality, and secondary outcomes of interest included overall mortality, 30-day mortality, prolonged intensive care unit stay (>72hours), and prolonged length of hospital stay (>10days), and other adverse events such as re-entry injury, need for re-exploration, need for mechanical circulatory support, prolonged mechanical ventilation (>48hours), need for permanent pace maker, stroke, renal dysfunction requiring renal replacement therapy, arrhythmia, and wound infection. Survival analysis was used to determine the association between demographics and perioperative variables of interest and rate of occurrence of outcomes of interest. Univariate and multivariate Cox- proportional hazard (Cox-PH) regression models were fitted to explore their relationship. Kaplan-Meir plots were fitted to visualise the probability of overall survival and freedom from adverse outcomes of interest.
Results: The mean age of the total cohort of redo aortic patients was 64.22 ± 12.22. Majority of the patients were males (n= 57, 69.3%) and underwent elective redo-aortic surgeries (n= 48, 62.3%). The mean Logistic Euroscore and Euroscore II were 33.25 ± 19.52 and 24.15 ± 20.89 respectively. The mean duration between redo surgeries was higher in females (12.45 ± 13.28) years compared to males (8.72 ± 7.93) years but this difference was not found to be statistically significant (p=0.243). The most common indication for redo surgery was aortic dilatation (n=41, 53.2%). Majority of the patients had a first redo-operation (n=69, 89.6%), while only one patient (0.3%) had a fourth redo. The most common surgery type was aortic arch surgery (frozen elephant trunk) with ascending aortic replacement (n=34, 44.1%). The mean duration of follow-up was 2.0 ± 1.7. The rate of freedom from in-hospital mortality was 63.1% (95% CI 35.4 – 100%). Overall survival rate at the end of the 5-year follow-up period was 73.1% (95% CI 62.6 – 85.4%). The factors found to be predictive of overall mortality were priority of surgery (HR 3.48, 95% CI 1.20-10.05, p=0.02), time to re-operation (HR 0.89, 95% CI 0.81–0.99, p=0.025), pre-op chronic kidney disease (HR 3.16, 95% CI 1.18-8.43, p=0.022), need for mechanical circulatory support (HR 12.7, 95% CI 4.23-38.12, p<0.001), post operative renal dysfunction (HR 4.03, 95% CI 1.50-10.79, p=0.006), and post op re-exploration (HR 47.82, 95% CI 13.9–164.4, p<0.001). Need for mechanical circulatory support (HR 7.74, 95% CI 2.09 – 28.69, p=0.002) was found to be predictive of in-hospital mortality.
Conclusion: Survival rates following redo aortic surgery in our centre are comparable with those gotten in other studies with immediate and 5-year outcomes shown to be favourable. In addition, several independent risk factors have been shown to be predictors of mortality.
Authors
Oluwanifemi Akintoye (1), Namrata Mishra (2), RAVI DE SILVA (1)
Institutions
(1) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom, (2) New Vision University Medical Student, Tbilisi, Georgia
Methods: Of the 348 patients who had redo-cardiac surgery in our centre from January 1st, 2018, to August 30th, 2023, 77 (22.1%) patients underwent redo aortic surgery and were included in this study. The primary outcome of interest was in-hospital mortality, and secondary outcomes of interest included overall mortality, 30-day mortality, prolonged intensive care unit stay (>72hours), and prolonged length of hospital stay (>10days), and other adverse events such as re-entry injury, need for re-exploration, need for mechanical circulatory support, prolonged mechanical ventilation (>48hours), need for permanent pace maker, stroke, renal dysfunction requiring renal replacement therapy, arrhythmia, and wound infection. Survival analysis was used to determine the association between demographics and perioperative variables of interest and rate of occurrence of outcomes of interest. Univariate and multivariate Cox- proportional hazard (Cox-PH) regression models were fitted to explore their relationship. Kaplan-Meir plots were fitted to visualise the probability of overall survival and freedom from adverse outcomes of interest.
Results: The mean age of the total cohort of redo aortic patients was 64.22 ± 12.22. Majority of the patients were males (n= 57, 69.3%) and underwent elective redo-aortic surgeries (n= 48, 62.3%). The mean Logistic Euroscore and Euroscore II were 33.25 ± 19.52 and 24.15 ± 20.89 respectively. The mean duration between redo surgeries was higher in females (12.45 ± 13.28) years compared to males (8.72 ± 7.93) years but this difference was not found to be statistically significant (p=0.243). The most common indication for redo surgery was aortic dilatation (n=41, 53.2%). Majority of the patients had a first redo-operation (n=69, 89.6%), while only one patient (0.3%) had a fourth redo. The most common surgery type was aortic arch surgery (frozen elephant trunk) with ascending aortic replacement (n=34, 44.1%). The mean duration of follow-up was 2.0 ± 1.7. The rate of freedom from in-hospital mortality was 63.1% (95% CI 35.4 – 100%). Overall survival rate at the end of the 5-year follow-up period was 73.1% (95% CI 62.6 – 85.4%). The factors found to be predictive of overall mortality were priority of surgery (HR 3.48, 95% CI 1.20-10.05, p=0.02), time to re-operation (HR 0.89, 95% CI 0.81–0.99, p=0.025), pre-op chronic kidney disease (HR 3.16, 95% CI 1.18-8.43, p=0.022), need for mechanical circulatory support (HR 12.7, 95% CI 4.23-38.12, p<0.001), post operative renal dysfunction (HR 4.03, 95% CI 1.50-10.79, p=0.006), and post op re-exploration (HR 47.82, 95% CI 13.9–164.4, p<0.001). Need for mechanical circulatory support (HR 7.74, 95% CI 2.09 – 28.69, p=0.002) was found to be predictive of in-hospital mortality.
Conclusion: Survival rates following redo aortic surgery in our centre are comparable with those gotten in other studies with immediate and 5-year outcomes shown to be favourable. In addition, several independent risk factors have been shown to be predictors of mortality.
Authors
Oluwanifemi Akintoye (1), Namrata Mishra (2), RAVI DE SILVA (1)
Institutions
(1) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom, (2) New Vision University Medical Student, Tbilisi, Georgia
Presentation Duration
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