P203. Management and Outcomes of Endocarditis-Related Aortic Root Pseudoaneurysms
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 progression of infectious endocarditis, destruction of the aortic annulus and root occurs, potentially resulting in aortic root pseudoaneurysms. The standard of care centers around aggressive debridement, reconstruction of any destroyed annulus, and replacement of any infected or necrotic tissue including the valve or root. The vast majority of literature surrounding the topic is related to case reports, and thus, we sought to evaluate our aortic center's institutional outcomes after root replacement for endocarditis-related aortic root pseudoaneurysms.
Methods:
A prospectively maintained institutional database was used to identify patients over the last 10 years who presented with endocarditis-related aortic root pseudoaneurysms. We describe any prior surgical history and temporal relationship to prior surgeries, and subsequent management strategy and outcomes.
Results:
A total of 15 patients with endocarditis-related aortic root pseudoaneurysms were identified. In addition to infectious symptoms, roughly half of the patients presented with additional cardiovascular symptoms, including stroke (2, 13.3%), pericardial effusion (2, 13.3%), and arrhythmia (complete heart block or new onset atrial fibrillation, 3, 20.0%). All but two of the patients had a prior aortic surgical history, except for two patients who presented primarily in the setting of bicuspid aortic valve disease. Most of the cohort had a previous aortic valve replacement (13, 86.7%), with a significant portion having an aortic or valve intervention within the past year (4, 26.7%). All patients underwent concomitant valve and root replacement including mechanical bentall, biobentall or homograft replacement. Roughly a third of patients required concomitant arch intervention of some form, with other adjunctive procedures including coronary artery bypass grafting, mitral valve replacement, and PFO closure. Approximately half of patients (7, 46.7%) were left open for either bleeding or serial washouts, with 2 (13.3%) requiring adjunctive mechanical circulatory support. Post-operatively, rates of coagulopathy were high (7, 46.7%), with a relatively high mortality rate (3, 20.0%).
Conclusions:
For endocarditis-related aortic root pseudoaneurysm to form, patients typically have severe enough progression in their disease that they can present with a number of additional life-threatening pathologies, furthermore, they are subject to increased morbidity and mortality due to their disease progression. Decisive surgical treatment with radical debridement, reconstruction of the annulus, and replacement of the valve and root is of paramount importance.
Authors
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Elizabeth Devine (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
With progression of infectious endocarditis, destruction of the aortic annulus and root occurs, potentially resulting in aortic root pseudoaneurysms. The standard of care centers around aggressive debridement, reconstruction of any destroyed annulus, and replacement of any infected or necrotic tissue including the valve or root. The vast majority of literature surrounding the topic is related to case reports, and thus, we sought to evaluate our aortic center's institutional outcomes after root replacement for endocarditis-related aortic root pseudoaneurysms.
Methods:
A prospectively maintained institutional database was used to identify patients over the last 10 years who presented with endocarditis-related aortic root pseudoaneurysms. We describe any prior surgical history and temporal relationship to prior surgeries, and subsequent management strategy and outcomes.
Results:
A total of 15 patients with endocarditis-related aortic root pseudoaneurysms were identified. In addition to infectious symptoms, roughly half of the patients presented with additional cardiovascular symptoms, including stroke (2, 13.3%), pericardial effusion (2, 13.3%), and arrhythmia (complete heart block or new onset atrial fibrillation, 3, 20.0%). All but two of the patients had a prior aortic surgical history, except for two patients who presented primarily in the setting of bicuspid aortic valve disease. Most of the cohort had a previous aortic valve replacement (13, 86.7%), with a significant portion having an aortic or valve intervention within the past year (4, 26.7%). All patients underwent concomitant valve and root replacement including mechanical bentall, biobentall or homograft replacement. Roughly a third of patients required concomitant arch intervention of some form, with other adjunctive procedures including coronary artery bypass grafting, mitral valve replacement, and PFO closure. Approximately half of patients (7, 46.7%) were left open for either bleeding or serial washouts, with 2 (13.3%) requiring adjunctive mechanical circulatory support. Post-operatively, rates of coagulopathy were high (7, 46.7%), with a relatively high mortality rate (3, 20.0%).
Conclusions:
For endocarditis-related aortic root pseudoaneurysm to form, patients typically have severe enough progression in their disease that they can present with a number of additional life-threatening pathologies, furthermore, they are subject to increased morbidity and mortality due to their disease progression. Decisive surgical treatment with radical debridement, reconstruction of the annulus, and replacement of the valve and root is of paramount importance.
Authors
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Elizabeth Devine (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.