P275. Re-Operative Aortic Root Replacement In Patients With Prior Aortic Valve or Root Replacement: A Single Center Experience
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Louisville, KY
United States - Contact Me
Toyokazu (Chris) Endo, M.D., is a PGY2 (General Surgery) in his dedicated research years at the University of Louisville Department of Cardiothoracic Surgery. He obtained his B.S. from Duke University and M.D. from Kirk Kerkorian School of Medicine at UNLV.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objectives: There are few studies that have evaluated the outcomes of patients undergoing a re-operative aortic root replacement after initial aortic valve replacement (AVR), or root surgery. The objective of this study was to evaluate the characteristics and outcomes of patients undergoing re-operative root replacement.
Methods: We evaluated a single-center cardiac surgery database from January 2014 to June 2023 to identify patients undergoing re-operative root replacement who had prior aortic valve, aortic root, ascending aortic, or any combination of these surgeries. Patients undergoing other prior cardiac procedures such as other valve repair/replacement, coronary artery bypass grafting, descending thoracic aortic surgery, or aortic arch surgery were excluded. Patient characteristics and outcomes were evaluated using descriptive statistics.
Results: A total of 59 patients (median age 63 years, 61% male) underwent re-operative root replacement during the study period after index aortic surgery. 49% had prior AVR, and 51% had prior root replacement. The indication for reoperation was predominantly due to new-onset aneurysm/pseudoaneurysm formation (39%), followed by degeneration of the initial prosthesis (34%) and endocarditis (27%). The median time between index surgery and reoperation was 8 (5-14) years. History of hypertension, type 2 diabetes, and prior MI were present in 81%, 20%, and 20% of patients, respectively. Median left ventricular ejection fraction was 55% (50-60) and creatinine was 1.0 mg/dl (0.8-1.4). The operative mortality was 6.4%, and the incidence of complications such as stroke, reoperation for bleeding, and renal failure were 3.4%, 7.1%, and 3.4%, respectively. Of 59 patients, 43 were seen again at a 1-year follow-up (median follow-up 2.5 years). One patient did require a late pacemaker placement, and none required a cardiac re-operation.
Conclusions: This single-center experience shows that re-operative aortic root replacement after prior AVR or root replacement is associated with acceptable early and mid-term mortality. No patients required late re-reoperations for the ascending aorta. Re-operative aortic root replacement may be a safe procedure for a select group of patients. A larger collaborative cohort may identify risk factors for adverse operative outcomes.
Authors
Toyokazu Endo (1), Jaimin Trivedi (1), Priyadarshini Chandrashekhar (1), Michele Gallo (1), Erin Schumer (1), Brian Ganzel (1), Mark Slaughter (1), Siddharth Pahwa (1)
Institutions
(1) University of Louisville School of Medicine, Louisville, KY
Methods: We evaluated a single-center cardiac surgery database from January 2014 to June 2023 to identify patients undergoing re-operative root replacement who had prior aortic valve, aortic root, ascending aortic, or any combination of these surgeries. Patients undergoing other prior cardiac procedures such as other valve repair/replacement, coronary artery bypass grafting, descending thoracic aortic surgery, or aortic arch surgery were excluded. Patient characteristics and outcomes were evaluated using descriptive statistics.
Results: A total of 59 patients (median age 63 years, 61% male) underwent re-operative root replacement during the study period after index aortic surgery. 49% had prior AVR, and 51% had prior root replacement. The indication for reoperation was predominantly due to new-onset aneurysm/pseudoaneurysm formation (39%), followed by degeneration of the initial prosthesis (34%) and endocarditis (27%). The median time between index surgery and reoperation was 8 (5-14) years. History of hypertension, type 2 diabetes, and prior MI were present in 81%, 20%, and 20% of patients, respectively. Median left ventricular ejection fraction was 55% (50-60) and creatinine was 1.0 mg/dl (0.8-1.4). The operative mortality was 6.4%, and the incidence of complications such as stroke, reoperation for bleeding, and renal failure were 3.4%, 7.1%, and 3.4%, respectively. Of 59 patients, 43 were seen again at a 1-year follow-up (median follow-up 2.5 years). One patient did require a late pacemaker placement, and none required a cardiac re-operation.
Conclusions: This single-center experience shows that re-operative aortic root replacement after prior AVR or root replacement is associated with acceptable early and mid-term mortality. No patients required late re-reoperations for the ascending aorta. Re-operative aortic root replacement may be a safe procedure for a select group of patients. A larger collaborative cohort may identify risk factors for adverse operative outcomes.
Authors
Toyokazu Endo (1), Jaimin Trivedi (1), Priyadarshini Chandrashekhar (1), Michele Gallo (1), Erin Schumer (1), Brian Ganzel (1), Mark Slaughter (1), Siddharth Pahwa (1)
Institutions
(1) University of Louisville School of Medicine, Louisville, KY
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.