P375. Valve sparing aortic root replacement in England: trends and outcomes from a national registry analysis
Bowdon
United Kingdom - Contact Me
Stuart is a consultant cardiac surgeon at South Tees Hospitals NHS Foundation Trust and honorary senior clinical lecturer. He undertook clinical training in cardiothoracic surgery across the North West of England and completed a post-CCT fellowship in advanced aortic surgery and TAVI at Toronto General Hospital. Stuart completed his PhD at the University of Manchester in 2013 on clinical prediction models in cardiovascular surgery. His research focus is on using big data and advanced analyses to improve cardiac surgery outcomes for patients. He has published widely on clinical risk prediction models, clinical outcome analyses, cardiopulmonary exercise testing and using large clinical registries. He is a member of the EACTS Research Taskforce, clinical lead for the Greater Manchester Health Informatics Collaborative and previously sat on the UK National Adult Cardiac Surgery Research Board.
Description
Valve-sparing aortic root replacement (VSRR) has been performed for over 40 years with excellent long-term outcomes for a range of pathologies reported in numerous studies. However, there is evidence that widespread standardized adoption of VSRR has been variable. The objective of this study was to assess trends in VSRR surgery activity and outcomes across England.
Methods
Data from the UK National Adult Cardiac Surgery Audit (NACSA) were obtained from the National Institute of Cardiovascular Outcomes Research (NICOR) central cardiac database. Patients who underwent aortic root surgery between March 2011 and March 2019 were included, and patients who underwent VSRR by any technique were identified. Geographical regions in England were defined with the Kruskal-Wallis test used to assess the rate of VSRR as a proportion of all aortic root surgery. The primary outcome of the study was in-hospital mortality.
Results
A total of 618 VSRR were performed during the study period across 40 centers by a total of 165 consultant surgeons. VSRR represented 8.3% of all aortic root surgery (618/7472). The majority of VSRR (78.1%, 483/618) were performed electively. The median age at operation was 51 (IQR 37-63), and most patients were male (68.6%, 424/618). The median EuroSCORE II was 0.86 (IQR 0.61, 1.67). The overall in-hospital mortality was 2.8% (17/618), with an elective mortality of 1.4% (7/483). The overall rate of permanent stroke was 2.6% (16/618), with a permanent stroke rate for elective patients of 1.7% (8/483). The mean number of cases performed per year was 68.66 (SD 24.61), and the mean number of cases per consultant surgeon per year was 4.61 (SD 7.54). The number of cases per year increased from 42 in 2011 to 72 in 2018. There was evidence of variation between geographical regions in the rate of VSRR as a proportion of all aortic root surgery.
Conclusions
This analysis of national registry data demonstrates a significantly lower overall rate of VSRR as a proportion of all aortic roots compared to other national series. Despite all included centers performing at least one VSRR during the study period, there was evidence of geographical variation in the rate of VSRR. Despite relatively low consultant and hospital volumes, short-term clinical outcomes were excellent. Further work is required to ensure equity of access to VSRR across England.
Authors
Stuart Grant (1), Daniel Fudulu (2), Tim Dong (2), Cha Rajakaruna (2), Gianni Angelini (2), Enoch Akowuah (1), Tirone David (3)
Institutions
(1) South Tees NHS Hospitals Foundation Trust, United Kingdom, (2) Bristol Heart Institute, United Kingdom, (3) Toronto General Hospital, Toronto, ON