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204. First Results of a Dutch Cohort of Patients Undergoing Personalized External Aortic Root Support

May 8, 2023


Source:
103rd Annual Meeting, the Los Angeles Convention Center, Los Angeles, CA, USA
Los Angeles Convention Center, 403B
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OBJECTIVE:
Patients with connective tissue disease with aortic root aneurysm are at risk of dissection and progression of the dilatation. Standard treatment is either a total root replacement or a valve-sparing root replacement. Both procedures have drawbacks such as the need for anticoagulation and complications of the aortic valve. Personalized External Aortic Root Support has been introduced to reduce these risks with similar beneficial outcome. Our purpose is to evaluate the safety and efficacy in the first patients undergoing Personalized External Aortic Root Support in the Netherlands.
METHODS:
From January 2018 to September 2022, a total of 76 patients underwent either an isolated Personalized External Aortic Root Support procedure or Personalized External Aortic Root Support with concomitant valve- and/or rhythm surgery or a combined Ross and Personalized External Aortic Root Support procedure in two centres. Isolated Personalized External Aortic Root Support was generally performed off-pump under controlled hypotension. Patient characteristics, preoperative and postoperative echocardiography and computed tomography or magnetic resonance imaging were assessed.
RESULTS:
Median age was 34 (SD±15) years and 51 (67%) patients were male. Among all patients 36 (48%) had Marfan syndrome, 10 (13%) Loeys-Dietz syndrome and 18 (24%) had a bicuspid aortic valve. Fifty three (70%) patients underwent isolated Personalized External Aortic Root Support, 17 (22%) a Ross-Personalized External Aortic Root Support and 6 (8%) patients underwent Personalized External Aortic Root Support with concomitant surgery. Mean sinus of Valsalva diameter prior to surgery was 45.1 mm (SD±5.1). All but one patient had a successful placement of root support. Three patients (in the isolated Personalized External Aortic Root Support group) were converted to cardiopulmonary bypass. Two Ross-Personalized External Aortic Root Support patients needed reoperation due to Personalized External Aortic Root Support-related issues in the follow-up period. No death, aortic dissection, endocarditis or thrombo-embolic complications occurred in 32 postoperative patient years of follow-up. At follow-up all aortic diameters were stable or even reduced (median 39.5 (IQR 36-42)).
CONCLUSIONS:
Personalized External Aortic Root Support has promising in-hospital and early follow-up results in selected patients. Longer follow up is needed to assess the incidence of late aortic complic


Athiná Kougioumtzoglou (1), David Koolbergen (2), Mark Hazekamp (3), Berto Bouma (2), (1) Amsterddam UMC, Amsterdam, (2) Amsterdam UMC, Amsterdam, NA, (3) Leiden University Medical Center, Leiden, AK


Vaughn Starnes

Invited Discussant

Dr. Starnes joined the Department of Surgery as a Hastings Professor of Cardiothoracic Surgery and Director of the Heart and Lung Transplant Program in 1992 and became Chairman of Cardiothoracic Surgery in 1997. He was named a Distinguished Professor of Cardiothoracic Surgery in 2004 and became Chair and Surgeon-in-Chief of the Department of Surgery in 2008. As the founding Director of the USC Cardiac and Vascular Institute, Dr. Starnes has built an interdisciplinary powerhouse comprised of clinicians and basic scientists who are exploring better and more innovative ways of treating heart disease. Under his leadership, USC surgeons have conducted more than 16,000 open heart surgeries to repair and replace valves or create coronary artery bypasses, and more than 10,400 surgeries for diseases of the lungs, esophagus, and chest wall. Dr. Starnes also serves as the Division Head of the Children’s Hospital Los Angeles Heart Institute. When he was recruited in 1992, the program was performing 125 surgeries a year. Under his leadership, the Institute has now grown to more than 1,000 cases a year. Dr. Starnes has an ongoing interest in congenital heart disease and minimally invasive repair and replacement of the valves of the heart. He is actively involved in research on stem-cell therapy for congenital heart defects and in clinical trials investigation of new valve technology, including percutaneous heart valve replacement. He has authored and co-authored over 200 publications.  Dr. Starnes other major areas of research include adult acquired heart disease, tissue engineering, and heart, heart-lung, and lung transplantation. Dr. Starnes served as President of the Western Thoracic Surgical Association in 2003 and on the Examination Committee and Examination Consultation Committee of the American Board of Thoracic Surgery. Dr. Starnes was honored to serve as the 100th President of the American Association for Thoracic Surgery.

 

Athiná Kougioumtzoglou

Abstract Presenter

Resident Cardiothoracic Surgery 

Specialties: Adult Cardiac, Aortic Valve, Anatomy and Conditions, Great Vessels, Aortic root, Aortic dissection (includes ulcers, hematomas), Valve, Aortic Valve, Treatment/Procedure/Operation/Surgery, Valve, Aortic valve, Congenital, Aortic Valve, Anatomy and Conditions, Heart Defects, Genetic Abnormalities