P330. The Challenge of Achieving Good Results in Complex Aortic Emergencies by New Faculty: In-depth Analysis of First 100 Consecutive Cases
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Cleveland Clinic Foundation
Chagrin Falls, OH, OH
United States - Contact Me
Marijan Koprivanac MD, MS, is a cardiothoracic surgeon at Cleveland Clinic. He graduated from University of Zagreb, School of Medicine in 2009. He then completed a Masters in Science and Clinical Research at Case Western University. He further graduated from Cleveland Clinic General Surgery Residency Program and Cardiac Surgery Fellowship at University of Pennsylvania, followed by completing an Aortic Fellowship Program at the Cleveland Clinic.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Surgical skill and experience are known to be associated with improved outcomes in acute aortic syndrome (AAS). Aortic programs face the challenge of ensuring that new faculty are well prepared to take on such complex cases without compromising outcomes. Here we review the initial experience of a new faculty at a large aortic center in the context of processes in place to optimize results.
Methods: From January 13, 2022, to December 4, 2023, a total of 101 patients diagnosed with AAS underwent surgical repair by a single surgeon. Excluded from this study, were 5 patients (all >87 yrs and at nursing homes/assisted living) who were deemed unsuitable for surgery, and 3 patients who experienced mortality during hospital transfer. Mean age was 62 yrs and 61 were male. Average BMI was 31, 88 had hypertension, 7 recent drug use, 2 on dialysis, 11 with CKD, and 12 received antithrombotic therapy. The aortic center has an AAS volume of >100 cases/year and incorporates advanced logistics, transport and communications and multidisciplinary care including imaging, endovascular, and critical care services.The surgeon spent 6 months of additional aortic training after completing cardiothoracic residency and before starting independent practice.
Results: Among the 101 patients, 79 were DeBakey Type 1 and 16 were Type 2 dissections. Additionally, 3 patients presented with intramural hematoma, 2 with perforating ulcers in the ascending, and 1 with an arch mycotic pseudoaneurysm. Twelve cases were redo procedures. The distribution of entry tears was: ascending aorta (52), arch (36), descending (8), left subclavian artery (1), and femoral artery (1). For DeBakey Type 1 patients, 54 had supraaortic dissection, including 4 with complete occlusions of the right carotid artery and 1 with occlusion of the right subclavian artery. Forty eight patients exhibited dissections extending to the iliac vessels, with 15 experiencing lower extremity malperfusion due to static obstruction. Nineteen patients had compression of the superior mesenteric artery, 7 of which had static obstruction. Two patients had complete occlusions of the infrarenal abdominal aorta. Clinical presentations included 2 patients with bloody bowel movements, 8 with stroke, 2 withTIA, 10 with intubation prior to transfer, and 16 with lower extremity symptoms. Additionally, 5 patients required preoperative pressors, and 5 experienced cardiac arrest in the operating room. GERAADA score and UPenn classification are summarized in Table. Sixty-one patients underwent arch procedures with a frozen elephant trunk (B-SAFER), 3 had Zone 1 arch, 1 zone 2 and 1 total arch. Thirty-four patients received hemiarch replacement. Twenty-three patients underwent root replacement, with 20 receiving a biobentall, 2 undergoing valve-sparing root replacement, and 1 receiving a homograft. Direct aortic cannulation was performed in 93 patients, axillary in 6, innominate in 1, and Samurai cannulation in 1 patient. There were 4 (4%) perioperative deaths and 4 strokes. Nine patients required tracheostomy and 5 required dialysis.
Conclusions: In a setting of a cumulative institutional experience and culture of teamwork managing complex patients with AAS can be achieved with good outcomes by a junior surgeon. The modern take on managing these patients including multidisciplinary care and technical innovations allows safe operations on some patients who were previously deemed at prohibitive risk for surgery.
Authors
Marijan koprivanac (1), Filip Stembal (1), Patrick Vargo (1), Xiaoying LOU (1), Eric Roselli (1), Faisal Bakaeen (1), Marc Gillinov (1), Edward Soltesz (1), Michael Tong (1), Shinya Unai (1), Nicholas Smedira (1), Gosta Pettersson (1), Haytham Elgharably (1), Richard Ramsingh (1), Francis Caputo (1), Jon Quatromoni (1), Ali Khalifeh (1), Sean Lyden (1), Paul Schoenhagen (1), Vidyasagar Kalahasti (1), Marta Kelava (1), Venu Menon (1), Andrej Alfirevec (1), Mariya Geube (1), Lars Svensson (1), Mar
Institutions
(1) Cleveland Clinic, Cleveland, OH
Methods: From January 13, 2022, to December 4, 2023, a total of 101 patients diagnosed with AAS underwent surgical repair by a single surgeon. Excluded from this study, were 5 patients (all >87 yrs and at nursing homes/assisted living) who were deemed unsuitable for surgery, and 3 patients who experienced mortality during hospital transfer. Mean age was 62 yrs and 61 were male. Average BMI was 31, 88 had hypertension, 7 recent drug use, 2 on dialysis, 11 with CKD, and 12 received antithrombotic therapy. The aortic center has an AAS volume of >100 cases/year and incorporates advanced logistics, transport and communications and multidisciplinary care including imaging, endovascular, and critical care services.The surgeon spent 6 months of additional aortic training after completing cardiothoracic residency and before starting independent practice.
Results: Among the 101 patients, 79 were DeBakey Type 1 and 16 were Type 2 dissections. Additionally, 3 patients presented with intramural hematoma, 2 with perforating ulcers in the ascending, and 1 with an arch mycotic pseudoaneurysm. Twelve cases were redo procedures. The distribution of entry tears was: ascending aorta (52), arch (36), descending (8), left subclavian artery (1), and femoral artery (1). For DeBakey Type 1 patients, 54 had supraaortic dissection, including 4 with complete occlusions of the right carotid artery and 1 with occlusion of the right subclavian artery. Forty eight patients exhibited dissections extending to the iliac vessels, with 15 experiencing lower extremity malperfusion due to static obstruction. Nineteen patients had compression of the superior mesenteric artery, 7 of which had static obstruction. Two patients had complete occlusions of the infrarenal abdominal aorta. Clinical presentations included 2 patients with bloody bowel movements, 8 with stroke, 2 withTIA, 10 with intubation prior to transfer, and 16 with lower extremity symptoms. Additionally, 5 patients required preoperative pressors, and 5 experienced cardiac arrest in the operating room. GERAADA score and UPenn classification are summarized in Table. Sixty-one patients underwent arch procedures with a frozen elephant trunk (B-SAFER), 3 had Zone 1 arch, 1 zone 2 and 1 total arch. Thirty-four patients received hemiarch replacement. Twenty-three patients underwent root replacement, with 20 receiving a biobentall, 2 undergoing valve-sparing root replacement, and 1 receiving a homograft. Direct aortic cannulation was performed in 93 patients, axillary in 6, innominate in 1, and Samurai cannulation in 1 patient. There were 4 (4%) perioperative deaths and 4 strokes. Nine patients required tracheostomy and 5 required dialysis.
Conclusions: In a setting of a cumulative institutional experience and culture of teamwork managing complex patients with AAS can be achieved with good outcomes by a junior surgeon. The modern take on managing these patients including multidisciplinary care and technical innovations allows safe operations on some patients who were previously deemed at prohibitive risk for surgery.
Authors
Marijan koprivanac (1), Filip Stembal (1), Patrick Vargo (1), Xiaoying LOU (1), Eric Roselli (1), Faisal Bakaeen (1), Marc Gillinov (1), Edward Soltesz (1), Michael Tong (1), Shinya Unai (1), Nicholas Smedira (1), Gosta Pettersson (1), Haytham Elgharably (1), Richard Ramsingh (1), Francis Caputo (1), Jon Quatromoni (1), Ali Khalifeh (1), Sean Lyden (1), Paul Schoenhagen (1), Vidyasagar Kalahasti (1), Marta Kelava (1), Venu Menon (1), Andrej Alfirevec (1), Mariya Geube (1), Lars Svensson (1), Mar
Institutions
(1) Cleveland Clinic, Cleveland, OH
Presentation Duration
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