P049. Aortic Root Replacement with Stentless Xenografts at Community Hospital
Carilion Roanoke Memorial Hospital
VA
United States - Contact Me
My name is Jinman Cai (MD). I am currently a third year general surgery resident at Carilion Clinic, Virginia Tech Carilion School of Medicine. After obtaining Bachelor's degree in Biochemistry and Economics at University of Virginia, my passion for medicine and commitment to excellence propelled me to achieve my Doctor of Medicine (MD) degree from University of Pittsburgh School of Medicine. I first discovered my interest in thoracic surgery during my medical school years. However, a brief exposure during the surgery rotation was insufficient to conclusively determine my preference over other surgical sub-specialties. It wasn't until residency that I truly delved into the technical intricacies of various operations and gained a deeper understanding of caring for patients with diverse disease processes. Cardiothoracic surgery, both in terms of the patients and the procedures, demands an unparalleled level of dedication, precision, and finesse compared to other surgical specialties. This discipline allows for an immediate and profound impact on a patient's quality of life. The intricacies of physiology and anatomy have fascinated me like no other, drawing me to the challenge of mastering these nuances in the operating room. Furthermore, cardiothoracic surgery stands at the vanguard of medical innovation with ongoing advancements from minimally invasive techniques to advanced surgical equipment. My keen interest in robotics further solidifies this career path as a natural fit for me.
Description
Methods: This study included all patients at least 18 years of age, undergoing aortic root replacement using stentless valve from 1985 to 2021. Data were retrospectively extracted from a prospectively maintained cardiac surgical database. Stentless aortic root replacement was performed via standard median sternotomy. Baseline characteristics and operative characteristics are presented as means ± standard deviation for continuous and parametric variables, and percentage (frequency) for categorical variables. Primary outcome is 30-day mortality. Secondary outcome includes complications such as stroke, deep sternal wound infection, re-exploration for mediastinal bleeding, postoperative sepsis, pulmonary ventilation > 24 hours, pneumonia, renal failure requiring dialysis, new-onset atrial fibrillation, new pacemaker and blood products transfused. Patients were followed immediate postoperative, then 1 month, 3 month, 6 month and yearly up to 17 years with echocardiography. Logistic regression analysis was performed to assess the impact of various factors on 30-day mortality, utilizing a stepwise model to select only the variables that significant impact death rate (p < 0.2).
Results: A total of 326 patients who underwent aortic root replacement using the stentless valve were included in the study. 69 patients (21.17%) had prior cardiac or valve surgery. 132 operations (40.49%) were performed with urgent or emergent status. The mean cardiopulmonary bypass time for all patients was 227.88 ± 92.85 minutes. The mean cross-clamp time for all patients was 169.12 ± 64.72 minutes. The overall 30-day mortality was 14.72%, but that for elective case was 7.22%. For patients who underwent root replacement only without concomitant procedures, the overall 30-day mortality was 6.45% and that for elective cases was 4.55%. The most common postoperative morbidity was atrial fibrillation, with an incidence of 35.28% in overall group and 33.51% in elective group. Immediate postoperative, 1 month, 3 month, 6 month, then yearly follow-up transvalvular mean gradients were 10.11, 7.36, 6.83, 5.49, 7.59 mmHg respectively. Logistic regression analysis performed to assess the impact of various factors on 30-day mortality showed that cardiopulmonary bypass time, cross-clamp time, re-exploration for mediastinal bleeding, renal failure requiring dialysis, new-onset atrial fibrillation and concomitant Cabrol procedure placed a significant role in affecting the 30-day mortality.
Conclusions: Aortic root replacement with stentless xenografts represents a significant advancement in cardiac surgery. Their superior hemodynamic performance, favorable clinical outcomes, long-term durability, and expanding applications make them a valuable option for patients requiring aortic root replacement despite the increased technical aspects of the operation. Favorable outcomes can be achieved even in non-academic community hospitals with aortic root replacement.
Authors
Jinman Cai (1), Mamata Tokala (1), W. Scott Arnold (1), Joseph Baker (1), David Wyatt (1), Joseph Rowe (1), Cynthia Choate (1), Mark Joseph (1)
Institutions
(1) Virginia Tech Carilion School of Medicine, Roanoke, VA