90th Annual Meeting Abstracts
Are Thromboembolic And Bleeding Complications A Drawback For Composite Aortic Root Replacement?
*Emily A Farkas, MD1, *Melody Anderson, BS1, *Ioannis Hatzaras, MD2, John A Elefteriades3
1St. Louis University School of Medicine, St. Louis, MO;2Ohio State University School of Medicine, Columbus, OH, CT;3Yale School of Medicine, New Haven, CT
Objectives: Valve-preserving aortic root reconstruction is being performed with increasing frequency. Independent of durability concerns, enthusiasm for retaining the native valve is often championed against the presumption that traditional composite-graft replacement of the aorta (CGRAo) will be complicated by thromboembolism and bleeding. Because the risk of these complications is highest in the early to mid-term following surgery, this study looks specifically at thromboembolism and bleeding during this timeframe.
Methods: Patients who had CGRAo over a 13-year interval were identified. Follow-up information was obtained by review of perioperative data entered into a prospectively maintained database. Kaplan-Meier disease-free and overall survival analyses were performed.
Results: One-hundred ninety (153 male, 37 female) patients underwent CGRAo between 1995 and 2008. Mean age was 56 years. Indication for surgery was chronic aneurysm in 170, and type A dissection in 20. St. Jude mechanical valve-conduits were used in 164 (86.3%); 26 patients (13.7%) received a biological conduit. Hospital mortality was 3.1% (6/190). Postoperative follow-up ranged from 1-151 months (mean 35.2). Rate of thromboembolism was 1.0% and rate of bleeding was 3.7%. Kaplan-Meier curves showed freedom from bleeding and thromboembolism as 97.7% (CI=95%,SD=3.1) at 60 months, and 95.2% (CI=95%,SD=5.2) at 84 months (FIG-1). Survival was 98.0% (CI=95%,SD=2.60) at 60 months, and 94.1% (CI=95%,SD=5.9) at 84 months.
Conclusions: Few thromboembolism and bleeding complications were experienced after composite-graft replacement of the aorta. These data supporting minimal morbidity with CGRAo in the setting of well-established durability should be used to put alternative procedures, such as valve-preserving aortic root reconstruction, into context.