P324. Surveillance After Proximal Aortic Surgery: What are the data
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
United Kingdom - Contact Me
In 2010 Miss Greco completed the Italian national training program in cardiac surgery at Tor Vergata, University of Rome, Italy, where she trained with Prof Chiariello and De Paulis’ team in a well-known Italian aortic unit.
In May 2018 she was awarded a European PhD in Innovative Technology and Medical Engineering for Surgery with a thesis on Clinical Outcomes of Personalised Aortic Root Support (Tor Vergata, University of Rome, Italy in collaboration with the John Radcliffe Hospital, Oxford.
From January 2011 to October 2015 Miss Greco worked as Specialty Doctor at the Sheffield Teaching Hospitals and from 2015 to 2019 she covered the position of aortic fellow at the John Radcliffe Hospital in Oxford, where she contributed in developing the Oxford complex aortic programme under the guidance of Prof Westaby and Mr Petrou. Miss Greco was appointed as Locum Consultant Cardiac Surgeon at Nottingham University Hospitals in 2019 and as Consultant Cardiac Surgeon with an interest in Aortic & Aorto-Vascular Surgery at Sheffield Teaching Hospitals in January 2020. Her main interests include major aortic surgery, re-do complex aortic procedures, aortic valve repair techniques and treatment of aortic dissection.
Description
Olaniran Omodara1,Sana Khan1,Massimo Capoccia1,Syed Sadeque1,Govind Chetty1,Graham Cooper1,Stefano Forlani1,Renata Greco1
1Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
BACKGROUND AND OBJECTIVE
Radiological surveillance after proximal thoracic aortic surgery is recommended by the current aortic guidelines based on level C evidence. The length and frequency of the follow-up are not specified, particularly for patents with no history of aortic dissection. Strict radiological surveillance following aortic surgery is challenging to organise. The objective of this study is to review our 20 years radiological surveillance data to identify the patients at risk for complications and progression of the thoracic aortic disease.
METHODS
We prospectively collected data on 565 patients with ascending aorta and/or aortic root surgery between 2003 and 2022. We excluded those with acute and chronic dissections. 48.5% of the patients underwent ascending aorta replacement and 52.5% aortic root replacement. 256 (45.3%) patients had a bicuspid aortic valve, 34 (6%) had confirmed Marfan's or Loeys-Dietz's syndrome and 23 (4%) had history of endocarditis/infection. CT/MRA of the aorta were performed within 6 months and annually after surgery. All the scans were reported by a vascular radiologist. For this study, we monitored clinical outcomes, compared the first post-operative and last follow-up scan to identify any signs of significant progression, defined as ≥5mm increase in the aortic diameter.
RESULTS
The first follow-up scan (at 6.8 ± 7.9 months) was available for 456(80.71%) patients. The scans showed no evidence of pseudo-aneurysm, a peri-graft collection in 26(5.7%) patients. Residual disease was present in 61(13.4%) patients: 14 had a root, 28 a distal ascending aorta and 31 a descending thoracic aorta ≥45mm. Four developed a pseudo-aneurysm during the follow-up. Two pseudo-aneurysms originated from the coronary re-implantation site, both occurred at an early stage of the follow-up(2.3 months and 11.1 months). Two delayed pseudo-aneurysm formations were observed in two patients at 2.5 and 6 years, both had residual descending thoracic disease. Six(1.06%) required a re-operation: 2 pseudo-aneurysm repair, 1 aortic root replacement for residual root aneurysm, 3 re-do AVRs. Two required thoracic and abdominal endovascular treatment. The surveillance scan (average follow-up 7.00 ± 7.08 years) was available for 442(78%) patients and showed peri-graft collection in 7(1.6%) and significant progression of the aortic disease in 28(6.2%): 2 of the root, 11 of the distal ascending, 17 of the descending thoracic aorta. 32 patients had an adverse combined outcome (4 pseudoaneurysm formations, 28 significant progression of the aortic disease). Residual aortic disease at first follow-up scan and peri-graft collection (p<0.001) were the two radiological signs associated with adverse outcome.
CONCLUSION
An early post-operative scan alone is not sufficient to exclude surgical complications. The two radiological factors associated with adverse outcome were the presence of peri-graft collection and residual aortic disease at early follow-up scan. Strict radiological follow-up should be recommended for the first 5 years after surgery, longer follow-up should be mandatory for patients with residual aortic disease.
Authors
Olaniran Omodara (1), Sana Khan (1), Massimo Capoccia (1), SYED SADEQUE (1), Govind Chetty (1), Stefano Forlani (1), Graham Cooper (1), Renata Greco (1)
Institutions
(1) Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom