Aortic Valve Sparing Aortic Root Replacement

S178

Abstracts

ABSTRACTS

Results for posterior leaflet repair were favourable (OR 0.76, p = 0.27). Conclusion: MVR is a durable procedure with excellent reoperation free survival rates. Mitral valve leaflet restriction reduces success of MVR. Posterior leaflet prolapse is a more favourable indication than anterior leaflet prolapse or ischaemic mitral regurgitation. doi:10.1016/j.hlc.2007.06.442 438 Preoperative Metabolic Therapy Improves Outcomes From Cardiac Surgery: A Prospective Randomised Clinical Trial Leong J.Y. 1,2,∗ , Pepe S. 1,2 , Van der Merwe J. 1,2 , Calderone A. 1,2 , Esmore D. 1,2 , Krum H. 1,2 , Rosenfeldt F.L. 1,2 1 The Cardiac Surgical Research Unit, CJOB Cardiothoracic Department, The Alfred Hospital, Monash University, Australia; 2 Baker Heart Research Institute, Melbourne, Australia

Introduction: The typical patient presenting for cardiac surgery currently is elderly with multiple co-morbidities. These high-risk patients contribute disproportionately to postoperative morbidity and mortality. We have shown that metabolic therapy with selenium and antioxidants such as coenzyme Q10 (CoQ10 ) and lipoic acid, as well as energy substrate precursors such as orotate have protective effects on the stressed myocardium. We postulated that such therapy would reduce myocardial damage and improve post-operative recovery. Aims: To assess the effect of perioperative metabolic therapy on clinical and biochemical outcomes of cardiac surgery. Methods: Patients (n = 117), mean age 65 years, undergoing elective coronary artery bypass graft (CABG) or valve surgery were randomised to receive for a minimum of 2 weeks before, and for 4 weeks after surgery, metabolic therapy (CoQ10 100 mg tds, magnesium orotate 400 mg tds, alpha-lipoic acid 100 mg tds, omega-3 fatty acids 333 mg tds and selenium 200 ␮g) or placebo. Results: In the whole group, metabolic therapy versus placebo was associated (multivariate analysis) with lower 24-h postoperative plasma troponin I (1.44 ± 0.25 versus 2.65 ± 0.61 ␮g/L, p = 0.003) and reduced postoperative hospital stay (6.9 ± 0.04 versus 8.1 ± 0.04 days, p = 0.002). In CABG alone (n = 70), metabolic therapy reduced the incidence of postoperative atrial fibrillation (23% versus 46%, p = 0.04, multivariate analysis). Conclusions: Metabolic therapy before cardiac surgery is associated with: (1) Reduced myocardial damage (troponin I release). (2) Shortened postoperative hospital stay. (3) Reduced incidence of postoperative atrial fibrillation in CABG. Clinical and economic benefits can be expected from general application of this therapy. doi:10.1016/j.hlc.2007.06.443

Heart, Lung and Circulation 2007;16:S1–S201

439 Aortic Valve Sparing Aortic Root Replacement G. Matalanis Austin Hospital, Studley Rd., Melbourne, Victoria, Australia Background: Standard aortic root replacement includes aortic valve replacement. Patients with aortic root dilatation or aneurysms, with or without severe aortic regurgitation, where the aortic valve tissue is normal, are candidates for aortic valve sparing root replacement (AVSRR) procedures to avoid the long-term risks of prosthetic valves. Methods: Data on patients undergoing AVSRR at the Austin Hospital, from January 1999 to July 2006 was reviewed. The surgical techniques will be described. All patients had intra-operative Transoesophageal echo. Clinical and echocardiographic follow-up was at 6 weeks, 3 months, and annually thereafter. Results: Fifty-five patients received AVSRR. Mean age was 61 years (18–83 years), and 69% were male. Whilst the majority had a trileaflet aortic valve, there were also six aortic dissections, four Marfan’s syndrome and four bicuspid valves. Additional procedures were required in 38 patients, including aortic arch replacement in 21 cases. There were three operative deaths; all of these had concomitant arch replacement. Mean follow-up was 29 months (3–84) and was 100% complete. The actuarial freedom from significant aortic regurgitation (AR) at 6 years was 89%. There were three reoperations for significant AR, all of which had uneventful simple valve replacement. Three patients are on warfarin for chronic Atrial Fibrillation, the rest receive aspirin alone. Conclusion: AVSRR offers patients the opportunity to avoid the potential complications of prosthetic valves. The procedure can be performed safely and has good medium durability. Long-term results are needed before it can be said that it is superior to bioprosthetic valves. doi:10.1016/j.hlc.2007.06.444 440 Surgical Interventions in Percutaneous Extraction—Case Series at Waikato Hospital

Lead

Deepak Mehrotra ∗ , Grant Parkinson, Zaw Lin, Ravi Ullal, Nand Kejriwal Cardiothoracic surgery Department, Waikato Hospital, Hamilton, New Zealand We report our 12-year surgical experience of five cases of percutaneous lead extractions of pacemakers and Implantable cardiac defibrillator (ICD) in which surgical intervention was required. Between July 1994 and January 2007, 40 patients underwent percutaneous pacemaker and ICD lead extraction procedure with five patients requiring onsite cardiac surgical intervention as complication secondary to lead extraction. Commonest reason of lead extraction was pocket infection or lead infection. First patient had SVC ruture