e2 Journal of Cardiovascular Medicine Vol 19, e-Supplement 2, November 2018
Methods Between 1996 and 2016, 938 consecutive patients (pts) underwent arch replacement in our center. We included only two groups of patients, according to the type of arterial cannulation: Axillary group with 282 pts and Femoral group with 409 pts. Baseline characteristics of the patients are reported in Table 1. Results The hemiarch replacement was performed more often in Femoral group (57.2% vs 38.3%, p = .001). The Femoral cannulation was the most commonly used in urgent/ emergent cases (56% vs 36.9%, p = .001). Cardiopulmonary bypass time (Axillary: 216.08 ± 61.47 vs Femoral: 203.78 ± 63.69; p = .001), Cross-Clamp Time (141.12 ± 47.5 vs 132.71 ± 49.10; p = .016), Circulatory Arrest Time (2.51 ± 1.74 vs 4.26 ± 2.49; p = .001) and antegrade selective cerebral perfusion time (69.19 ± 34.46 vs 58.84 ± 34.94; p = .001) were longer in Axillary group. Hospital mortality was similar between the two groups (12.1% vs 13.9%, p = .546) as well as for permanent neurological defi cit (6.7% vs 7.3%, p = .881). Transient neurological defi cit is signifi -cantly higher in the Axillary group (17.4% vs 11.0%, p = .022).
Conclusions Our study confi rms that Axillary and Femoral artery cannulations were associated with similar outcomes after aortic arch surgery. The Axillary cannulation was used more frequently in complex repair of the aortic arch, while the Femoral can be still considered a viable option, especially in urgent/emergent cases.
OC20 EARLY AND LONG-TERM RESULTS OF LATE REOPERATION AFTER REPAIRED ACUTE TYPE A AORTIC DISSECTION
D. Piani1, I. Vendramin1, A. Lechiancole1, V. Ferrara1, M. Meneguzzi1,
S. Sponga1, U. Livi1
1Cardiothoracic Department University Hospital of Udine Udine
Background and Aim Repaired type-A acute aortic dissection (TA-AAD) is a life-threating disease with unpredictable long-term evolution and prognosis. The aim of this study is to analyse causes, timing, and results of reoperation after primary surgery for TA-AAD.
Methods Between 1977 and 2017, 37 patients (mean age 60 ± 14 years, 86% male) underwent late reoperation for complicated repaired TA-AAD at our Institu-tion. Data was collected and analysed retrospectively.
Results Mean time of late reoperation was 64 ± 70 months. First procedures were ascending aorta ± emiarch replacement in 30 patients (7 AVR, 1 valve spar-ing) and ascending aorta + arch surgery in 7 patients (2 AVR, 1 valve sparing). In-hospital mortality was 5.4% (1 patient for infection and 1 for haemorrhagic shock). Overall survival was 86.1 ± 5.8 at 1 year, 68.8 ± 8.4% at 5 years, with a mean follow-up of 53 ± 50 months. Indications for redo-surgery were: pseudoa-neurysm of the bulb/residual ascending aorta (12), chronic dissection of the arch/ descending aorta (21), severe aortic insuffi ciency (4). Six patients (86%) previ-ously operated for total arch replacement underwent TEVAR as staged procedure (0% mortality) and 11 patients (37%) previously operated of ascending aorta ± emiarch underwent total arch replacement (none in-hospital death).
Conclusions In our experience surgical reoperation for repaired acute type-A aor-tic dissection can be safely performed and offers good results even in the
long-term. Furthermore, the endovascular approach, as part of a staged procedure for the treatment of residual descending aortic dissection, allows to achieve excellent long-term outcome with low operative risk.
OC24 ENDOVASCULAR SURGERY FOR ACUTE THORACIC AORTIC SYNDROMES
E. Di Tommaso1, L. Di Tommaso1, A. Iavazzo1, R. Smimmo1, R. Giordano1,
E. Pilato1, A. Saccenti2, G. Iannelli1
1Department of Cardiac Surgery, School of Medicine, University of Naples
“Federico II’’ Napoli, 2Department of Anesthesiology, School of Medicine,
University of Naples “Federico II’’ Napoli
Background and Aim Surgery of thoracic aortic emergencies is challenging and carries signifi cant high morbidity and mortality rate. In the last decade, Thoracic EndoVascular Aortic Repair (TEVAR) has shown improved early and late out-come, mostly in emergency. To assess early and long-term results after TEVAR for thoracic aortic emergencies we retrospectively reviewed our experience. Methods From March 2001 to March 2018, out of 289 patients undergone TE-VAR, we retrospectively reviewed 191 patients, 164 (85.9%) men; aged from 19 to 84 years, treated in urgent/emergent conditions: 51 patients (26.7%) for contained or free rupture of degenerative aneurysms, 118 (61.8%) for complicated acute or chronic type B aortic dissections and 22 (11.5%) for traumatic aortic injuries. Results The overall 30 days mortality was 4.4% (8 patients). Open surgical con-version was not required.. Periprocedural complications included arterial rupture or dissection (5.7%; 11 patients) and TIA/stroke (1.6%; 3 patients). Left subcla-vian artery (LSA) overstenting was achieved in 79 patients (41.3%). Follow-up ranged from 2 to 204 months and included clinical examinations and serial CT-scan. There were 8 late deaths aorta-related (4.4%). A secondary endovascular procedure was required in 13 pts (7.1%). One patient (0.5%), with retrograde aortic dissection, required open surgery. No patient with LSA overstenting re-quired a secondary revascularization or showed subclavian steal phenomenon. Conclusions The early and mid-term technical and clinical results supports the safety and effectiveness of thoracic endovascular surgery in patients with acute aortic syndromes too. More cases and longer follow-up are required.
OC38 LONG-TERM OUTCOME AFTER BENTALL OPERATION AND VALVE SPARING AORTIC ROOT REPLACEMENT IN ELECTIVE PATIENTS: A SINGLE CENTRE EXPERIENCE
M. Meneguzzi1, A. Lechiancole1, D. Piani1, I. Vendramin1, S. Sponga1, E.
Maz-zaro1, E. Spagna1, V. Tursi1, U. Livi1 1Cardiotoracico Udine
Background and Aim In aortic root surgery, Bentall procedure has been considered the procedure of choice.Valve sparing root-replacement (VSRR) techniques have gained popularity, avoiding prosthetis-related complications. However, long-term data to support this tendency are still lacking, and most of the studies included emergency procedures, that could infl uence the outcome.
The primary end-point was survival. Secondary end-point was freedom from Major Adverse Events(MAEs), including death, aortic-valve reoperation, major haemor-rhage, cerebrovascular events, aortic valve regurgitation (or dysfunction)>moderate. Methods Data of patients who underwent Bentall operation and VSRR from 1990 to 2017 in our centre were analysed. Emergency operations were excluded. Aortic valve stenosis were excluded from Bentall group.
Results 130 patients underwent Bentall operation (29 biological and 101 mechani-cal conduits). 98 patients underwent elective VSRR (64 reimplantation and 34 re-modeling techniques). Among baseline and operative data, in Bentall group were more bicuspid valves p < 0.001, previous cardiac operations p = 0.04, lesser pre-operative AF p = 0.05 and mean X-clamp time p = 0.001. Mean follow up dura-tion was 158 and 76 months in Bentall and VSRR groups.
