Abstracts: Suppl. 2 to Vol. 13 (September 15, 2011)

Abstracts/Interactive CardioVascular and Thoracic Surgery S65 Interactive CardioVascular and Thoracic Surgery 001 CONTEMPORARY OUTCOMES OF CONVENTIONAL AORTIC VALVE REPLACEMENT IN 638 OCTOGENARIANS: INSIGHTS FROM AN ITALIAN REGIONAL CARDIAC SURGERY REGISTRY M. Di Eusanio1, D. Fortuna2, D. Cristell3, P. Pugliese4, F. Nicolini5, D. Gabbieri6, M. Lamarra7, R. Di Bartolomeo1 1Cardiac Surgery Department, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; 2Regional Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy; 3Cardiac Surgery Department, Salus Hospital, Reggio Emila, Italy; 4Cardiac Surgery Department, Villa Torri Hospital, Bologna, Italy; 5Heart Surgery, University Medical School of Parma, Parma, Italy; 6Cardiovascular Surgery Department, Hesperia Hospital, Modena, Italy; 7Cardio-Vascular Surgery, GVM Hospitals of Care and Research, Lugo, Italy Objectives: Few data exist on contemporary outcomes after conventional aortic valve replacement in the elderly. Accordingly, we evaluated outcomes and identified predictors of reduced survival in a large contemporary series of octogenarians undergoing aortic valve replacement. Methods: The Regione Emilia Romagna Cardiac Surgery registry (RERIC) database (n=26,938) was queried for clinical features, and hospital and mid-term outcomes of octogenarians undergoing aortic valve replacement between 2003 and 2009. Hospital outcomes were also assessed in the subgroup of patients potentially eligible for transcatheter aortic valve implantation (age >80 and log EuroSCORE >15%). Predictors of hospital and mid-term mortality were identified. Results: The study population comprised 638 patients. NYHA class III–IV, congestive heart failure, cerebrovascular disease, and peripheral vasculopathy, mostly exacerbated the patients’ clinical profile. Mean log EuroSCORE was 13.0%. Overall hospital mortality and stroke rates were 4.5% and 1.3%, respectively. Other postoperative complications included renal failure (4.9%), intubation time >48 h (3.4%), complete atrio-ventricular block (4.4%). NYHA III–IV (OR=2.7) and CCS III–IV (OR=3.1) emerged as independent predictors of hospital mortality on multivariate analysis. Hospital mortality of octogenarians with log EuroSCORE >15% (mean: 23.1%) was 8.2% (P<0.001). At six years, octogenarians’ survival rate was similar to the expected survival of the ageand sex-matched 2006 regional population (67.5%). Shock (HR=2.6), peripheral neurologic dysfunction (HR=4.1) and mechanical prosthesis (HR=2.6) were independent risk factors for six-year mortality. Conclusions: This study, showing that contemporary outcomes after aortic valve replacement are excellent, may help to improve treatment decisionmaking in elderly patients with aortic valve disease. 002 FAILING STENTLESS AORTIC VALVES: REDO AORTIC ROOT OR ‘VALVE IN A VALVE’? J.R. Finch1, I. Roussin2, J. Pepper3 1Department of Cardiac Surgery, Royal Brompton Hospital, London, UK; 2Department of Echocardiography and CMR, Royal Brompton Hospital, London, UK; 3National Heart and Lung Institute, Imperial College London, Royal Brompton Campus, London, UK Objectives: In an era in which transcatheter aortic valve implantation is increasingly challenging the role of conventional primary and revision aortic valve surgery, we sought to review the risks, performance and durability of conventional open revision surgery performed for failing stentless aortic valves. Two contrasting techniques were evaluated: redo aortic root replacement vs. placement of a stented valve within the debrided stentless valve (‘valve in a valve’). Methods: We retrospectively reviewed a single surgeon’s experience of redo surgery for stentless valve failure (2000–2010), comparing perioperative morbidity and mortality, symptomatic status, echocardiographic parameters and re-intervention rate. Results: One hundred and eighteen redo procedures were performed for stentless aortic valve failure, of which 84 were homografts, 29 Toronto valves, three Ross pulmonary autografts, one Bicor stentless and one Freestyle root. Redo root surgery was performed in 53 cases (45%; aortic root alone in 38 patients) and ‘valve in a valve’ in 65 (55%; aortic valve alone in 49 patients). Average age at redo surgery was 61.9 and 61.2 years with a 30-day mortality of 11.3% and 1.5%, respectively. Mean follow-up was 5.6 years (range 1–11.2 years). Symptomatic, clinical and echocardiographic status were comparable. There were no re-interventions for paravalvular leaks or valve degeneration in either group. Conclusions: In selected patients, revision surgery using the ‘valve in a valve’ technique can be performed with low operative risk and excellent medium-term longevity. Barring excessive calcification, the majority of redo procedures can be performed in this fashion. 003 EARLY AND LATE OUTCOME AFTER AORTIC VALVE RECONSTRUCTION IN 127 PATIENTS: A SINGLE-CENTRE EXPERIENCE S. Leontyev, M.A. Borger, C. Trommer, S. Subramanian, S. Lehmann, M. Misfeld, F.W. Mohr Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany Objectives: To evaluate our early and late results after aortic valve reimplantation (David) surgery (AVR-D). Methods: A total of 127 patients underwent AVR-D. Patient age was 49±15 years, 25.1% (n=32) were female. Marfan syndrome was diagnosed in 23.6% (n=30), type A aortic dissection in 16.5% (n=21). The mean follow-up was 2.3±1.3 years (11 days–7.5 years), 92% (n=117) complete. Results: Early mortality was 1.6% (n=2), in patients with type A dissection. Pre-discharge echo revealed no patients having moderate or more aortic insufficiency (AI) and 16.5% patients (n=21) with trace or mild AI. During follow-up, aortic valve gradient and flow velocity increased from 7.1±4.2 mmHg to 10.1±6.6 mmHg (P=0.001) and 1.5±0.04 cm/s to 1.6±0.04 cm/s (P=0.2), respectively. LVEDD decreased significantly from 5.5±0.8 cm to 5.2±0.6 cm (P=0.002). Grade of AI increased significantly from the time of discharge (0.3±0.3) to the time of follow-up (0.5±0.5, P=0.03). In patients with Marfan syndrome, we observed an increase of AI grade from 0.4±0.08 to 0.7±0.1 (P=0.07) during follow-up, compared to other patients (0.3±0.03 vs. 0.4±0.06, P=0.05). Severe AI was diagnosed during follow-up in 3.1% of patients (n=4); AV endocarditis (n=2), prolapse of the non-coronary leaflet in patients with Marfan syndrome (n=2), all of whom underwent redo aortic valve replacement surgery. The five-year freedom from reoperation was 92±0.1%. Conclusions: Aortic valve reimplantation is associated with a low mortality rate and high freedom from reoperation rate, even in patients presenting with type A aortic dissection. We observed a slightly higher rate of recurrent aortic regurgitation in patients with Marfan syndrome. Monday A.M. Aortic valve I Monday 3 October 2011 08:30-10:00 Abstracts 001—058 Abstracts - 25th EACTS S66 Abstracts/Interactive CardioVascular and Thoracic Surgery 0 (...truncated)