- Email: [email protected]
Does the Cerebral Protection Strategy Alter Outcomes in Acute Type A Aortic Dissection Repair?
Abstracts
myocardial infarction was higher in the MAG group and atrial arrhythmias higher in the LIMA+SVG group. Matched 15 year survival curves demonstrated no significant differences between groups. Conclusion: Within the limitations of this study, we have found that in our centre, the choice of conduit does not affect survival for up to 15 years. There were also no differences in most in-hospital complications between groups. In spite of international literature reporting that arterial revascularisation is associated with better outcomes, we were unable to demonstrate this in our patient cohort. http://dx.doi.org/10.1016/j.hlc.2017.03.130 Does the Cerebral Protection Strategy Alter Outcomes in Acute Type A Aortic Dissection Repair? Alfred Hing, Dr ∗ , Matthew Shaw, Mr, Aung Oo, Prof Liverpool Heart and Chest Hospital, Merseyside, United Kingdom Purpose: The optimal strategy to minimise neurological morbidity and mortality following acute type A aortic dissection repair is unclear and remains controversial. There are a number of strategies employed, which include deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP) and antegrade cerebral perfusion (ACP). This study was designed to examine the outcomes of a variety of cerebral protection strategies used in our institution for acute type A dissection repair. Methodology: A retrospective review of our institution’s aortic surgery database was undertaken to compare outcomes of various cerebral protection strategies in acute type A dissection repairs. These included DHCA only, hypothermic circulatory arrest with ACP and hypothermic circulatory arrest with RCP. Data for this database was prospectively entered. Results: Preoperative characteristics between groups were similar. A variety of repair techniques were employed in the dissection repairs, including root replacement, ascending aorta, hemiarch and total arch replacement. Preliminary data analysis demonstrated that there were no significant differences between groups with regard to in-hospital mortality, stroke or reoperation for bleeding. Preliminary 3-year survival plots demonstrated no significant differences between groups. Conclusion: Preliminary analysis of the outcomes in type A dissection repairs in our institution have shown that the different cerebral protection strategies do not have a significant impact on outcomes. However, these results need to be considered in the context of the limitations of a retrospective analysis. Further analyses of this data will be undertaken. http://dx.doi.org/10.1016/j.hlc.2017.03.131
S399
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Propensity Matched Comparison of Surgical Aortic Valve Replacement With Transcatheter Aortic Valve Implantation: A Single Centre Experience Alfred Hing, Dr ∗ , Matthew Shaw, Mr, Aung Oo, Prof Liverpool Heart and Chest Hospital, Merseyside, United Kingdom Purpose: Transcatheter aortic valve implantation (TAVI) for aortic stenosis has been increasing, as demonstrated in the UK TAVI Registry Report. As TAVI patients are normally highrisk elderly patients, we undertook a propensity-matched study to compare outcomes of surgical aortic valve replacement (sAVR) with TAVI in order to exclude the confounding differences between patient groups that normally have surgery versus those with transcatheter procedures. Methodology: A retrospective review of our institution’s aortic surgery database with propensity score matching was undertaken to compare outcomes of sAVR versus TAVI. Data for this database is prospectively entered. Results: There were 2,102 sAVR and 260 TAVI performed between 2008-2016 with significant differences in most of their preoperative characteristics such as EuroSCORE (6.0 vs 17.3) and age (72 vs 84 years). After propensity score matching, there were 179 patients in each group with no significant differences in their preoperative characteristics. There were no significant differences between groups with respect to inhospital mortality (4.5% in each group), stroke (1.7% sAVR vs 2.2% TAVI), postoperative myocardial infarction (0.1% vs 0%) or pacemaker implantation (3.4% vs 3.9%). Hospital (11 vs 7 days) and critical care (3 vs 2 days) length of stay were higher in the sAVR group. There was a significant difference between groups in actuarial survival rates at 1-year (89.6% (sAVR) and 85.0% (TAVI)) and 5 years (62.7% and 43.2%). Conclusion: In our institution, in-hospital short-term outcomes are comparable between sAVR and TAVI. However, long-term survival is more favourable in those having a surgical approach to valve replacement than transcatheter routes. http://dx.doi.org/10.1016/j.hlc.2017.03.132 A “Hybrid” Hybrid Approach - Aortic Debranching Using a Trifurcate Graft for Arch and Descending Thoracic Aortic Aneurysm Repair With the ThoraflexTM Hybrid Graft Charles Jenkinson, Dr ∗ , Robert Larbalestier, Mr Fiona Stanley Hospital, Perth, WA, Australia Purpose: Pathology of the aortic arch and descending thoracic aorta poses many unique challenges for the cardiovascular surgeon. The ThoraflexTM hybrid device for the “frozen elephant trunk” procedure simplifies management of the descending thoracic aorta, whilst allowing anastomosis of the head and neck vessels to the proximal graft. We report our modification to the technique, involving the use of the Trifurcate Graft with Side Branch (Vascutek-Terumo Ltd, Ann
myocardial infarction was higher in the MAG group and atrial arrhythmias higher in the LIMA+SVG group. Matched 15 year survival curves demonstrated no significant differences between groups. Conclusion: Within the limitations of this study, we have found that in our centre, the choice of conduit does not affect survival for up to 15 years. There were also no differences in most in-hospital complications between groups. In spite of international literature reporting that arterial revascularisation is associated with better outcomes, we were unable to demonstrate this in our patient cohort. http://dx.doi.org/10.1016/j.hlc.2017.03.130 Does the Cerebral Protection Strategy Alter Outcomes in Acute Type A Aortic Dissection Repair? Alfred Hing, Dr ∗ , Matthew Shaw, Mr, Aung Oo, Prof Liverpool Heart and Chest Hospital, Merseyside, United Kingdom Purpose: The optimal strategy to minimise neurological morbidity and mortality following acute type A aortic dissection repair is unclear and remains controversial. There are a number of strategies employed, which include deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP) and antegrade cerebral perfusion (ACP). This study was designed to examine the outcomes of a variety of cerebral protection strategies used in our institution for acute type A dissection repair. Methodology: A retrospective review of our institution’s aortic surgery database was undertaken to compare outcomes of various cerebral protection strategies in acute type A dissection repairs. These included DHCA only, hypothermic circulatory arrest with ACP and hypothermic circulatory arrest with RCP. Data for this database was prospectively entered. Results: Preoperative characteristics between groups were similar. A variety of repair techniques were employed in the dissection repairs, including root replacement, ascending aorta, hemiarch and total arch replacement. Preliminary data analysis demonstrated that there were no significant differences between groups with regard to in-hospital mortality, stroke or reoperation for bleeding. Preliminary 3-year survival plots demonstrated no significant differences between groups. Conclusion: Preliminary analysis of the outcomes in type A dissection repairs in our institution have shown that the different cerebral protection strategies do not have a significant impact on outcomes. However, these results need to be considered in the context of the limitations of a retrospective analysis. Further analyses of this data will be undertaken. http://dx.doi.org/10.1016/j.hlc.2017.03.131
S399
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Propensity Matched Comparison of Surgical Aortic Valve Replacement With Transcatheter Aortic Valve Implantation: A Single Centre Experience Alfred Hing, Dr ∗ , Matthew Shaw, Mr, Aung Oo, Prof Liverpool Heart and Chest Hospital, Merseyside, United Kingdom Purpose: Transcatheter aortic valve implantation (TAVI) for aortic stenosis has been increasing, as demonstrated in the UK TAVI Registry Report. As TAVI patients are normally highrisk elderly patients, we undertook a propensity-matched study to compare outcomes of surgical aortic valve replacement (sAVR) with TAVI in order to exclude the confounding differences between patient groups that normally have surgery versus those with transcatheter procedures. Methodology: A retrospective review of our institution’s aortic surgery database with propensity score matching was undertaken to compare outcomes of sAVR versus TAVI. Data for this database is prospectively entered. Results: There were 2,102 sAVR and 260 TAVI performed between 2008-2016 with significant differences in most of their preoperative characteristics such as EuroSCORE (6.0 vs 17.3) and age (72 vs 84 years). After propensity score matching, there were 179 patients in each group with no significant differences in their preoperative characteristics. There were no significant differences between groups with respect to inhospital mortality (4.5% in each group), stroke (1.7% sAVR vs 2.2% TAVI), postoperative myocardial infarction (0.1% vs 0%) or pacemaker implantation (3.4% vs 3.9%). Hospital (11 vs 7 days) and critical care (3 vs 2 days) length of stay were higher in the sAVR group. There was a significant difference between groups in actuarial survival rates at 1-year (89.6% (sAVR) and 85.0% (TAVI)) and 5 years (62.7% and 43.2%). Conclusion: In our institution, in-hospital short-term outcomes are comparable between sAVR and TAVI. However, long-term survival is more favourable in those having a surgical approach to valve replacement than transcatheter routes. http://dx.doi.org/10.1016/j.hlc.2017.03.132 A “Hybrid” Hybrid Approach - Aortic Debranching Using a Trifurcate Graft for Arch and Descending Thoracic Aortic Aneurysm Repair With the ThoraflexTM Hybrid Graft Charles Jenkinson, Dr ∗ , Robert Larbalestier, Mr Fiona Stanley Hospital, Perth, WA, Australia Purpose: Pathology of the aortic arch and descending thoracic aorta poses many unique challenges for the cardiovascular surgeon. The ThoraflexTM hybrid device for the “frozen elephant trunk” procedure simplifies management of the descending thoracic aorta, whilst allowing anastomosis of the head and neck vessels to the proximal graft. We report our modification to the technique, involving the use of the Trifurcate Graft with Side Branch (Vascutek-Terumo Ltd, Ann