Aortic Root Archives - The Baird Institute

Early and Late Outcomes Following Valve Sparing Aortic Root Reconstruction: The ANZSCTS Database

April 12, 2016April 2, 2016 by Dhurandhar V, Parikh R, Saxena A, Vallely MP, Wilson MK, Black DA, Tran L, Reid C, Bannon PG

Dhurandhar V, Parikh R, Saxena A, Vallely MP, Wilson MK, Black DA, Tran L, Reid C, Bannon PG

Heart Lung Circ 2016 May;25(5):505-11

PMID: 26795638

Abstract

BACKGROUND: Valve sparing aortic root reconstruction (VSARR) has become an alternative to traditional aortic root replacement with a valved conduit. There have been various modifications but the two broad types are aortic root reimplantation and the aortic root remodelling procedure. We present the early and late outcomes following valve sparing aortic root reconstruction surgery in Australia.

METHODS: We reviewed the ANZSCTS database for patients undergoing these procedures. Preoperative, intraoperative and postoperative variables were analysed. Multivariable regression was performed to determine independent predictors of 30-day mortality. We also obtained five- and 10-year survival estimates by cross-linking the ANZSCTS database with the Australian Institute of Health and Welfare’s National Death Index.

RESULTS: Between January 2001 and January 2012, 169 consecutive patients underwent VSARR procedures. The mean age of the study population was 54.4 years with 31.4% being females. Overall, nine patients (5.9%) died within 30 days post procedure and five patients (3%) had permanent strokes. However, out of 132 elective cases, only five patients died (3.8%). Independent predictors of 30-day mortality were female gender [OR 5.65(1.24-25.80), p=0.025], preoperative atrial arrhythmia [OR 6.07(1.14-32.35), p=0.035] and acute type A aortic dissection [OR 7.71(1.63-36.54), p=0.01]. Long-term survival was estimated as 85.3% and 72.7% at five- and 10-years, respectively.

CONCLUSIONS: Along with an acceptable rate of early mortality and stroke, VSARR procedures provide good long-term survival according to the ANZSCTS database. As promising procedure for pathologies that impair the aortic root integrity, they can be adopted more widely, especially in Australian and New Zealand centres with experienced aortic units. Future studies are planned to assess freedom from valve deterioration and repeat surgery.

Nonsyndromic Thoracic Aortic Aneurysm and Dissection: Outcomes With Marfan Syndrome Versus Bicuspid Aortic Valve Aneurysm

April 12, 2016February 12, 2016 by Sherrah AG, Andvik S, van der Linde D, Davies L, Bannon PG, Padang R, Vallely MP, Wilson MK, Keech AC, Jeremy RW

Sherrah AG, Andvik S, van der Linde D, Davies L, Bannon PG, Padang R, Vallely MP, Wilson MK, Keech AC, Jeremy RW

J. Am. Coll. Cardiol. 2016 Feb;67(6):618-26

PMID: 26868685

Abstract

BACKGROUND: Genetic aortopathy (GA) underlies thoracic aortic aneurysms (TAA) in younger adults. Comparative survival and predictors of outcomes in nonsyndromic TAA (NS-TAA) are incompletely defined compared to Marfan syndrome (MFS) and bicuspid aortic valve (BAV).

OBJECTIVES: The study sought to compare survival and clinical outcomes for individuals with NS-TAA, MFS, and BAV.

METHODS: From 1988 to 2014, all patients presenting with GA 16 to 60 years of age were enrolled in a prospective study of clinical outcomes. Risk factors for death and aortic dissection were identified by Cox proportional hazards modeling and a mortality risk score developed.

RESULTS: Diagnosis of GA was made for 760 patients (age 36.9 ± 13.6 years, 26.8% female; NS-TAA, n = 311; MFS, n = 221; BAV, n = 228). MFS patients were younger than NS-TAA and BAV. Presentation with aortic dissection was more common for NS-TAA than MFS or BAV. The 687 patients surviving >30 days after presentation were followed for a median of 7 years. Calculated 10-year mortality was 7.8% for NS-TAA, 8.7% for MFS, and 3.5% for BAV (NS-TAA and MFS vs. BAV p <0.05). Factors associated with all-cause mortality were MFS (p = 0.04), age at presentation, and family history of dissection.

CONCLUSIONS: Clinical outcomes for MFS and NS-TAA are similar but worse than BAV. Independent predictors of mortality, including family history of aortic dissection and age, can be included in an Aortopathy Mortality Risk Score to predict survival. Management of NS-TAA, including surgical intervention, should be similar to that of MFS.

Thoracic aortic aneurysm: 4D flow MRI and computational fluid dynamics model

March 29, 2016October 15, 2015 by Callaghan FM, Karkouri J, Broadhouse K, Evin M, Fletcher DF, Grieve SM

Callaghan FM, Karkouri J, Broadhouse K, Evin M, Fletcher DF, Grieve SM

Comput Methods Biomech Biomed Engin 2015 Oct;18 Suppl 1:1894-5

PMID: 26237171

Abstract

Replacement of the aortic root with a composite valve-graft conduit: risk factor analysis in 246 consecutive patients

January 3, 2015December 3, 2014 by Woldendorp K, Starra E, Seco M, Hendel PN, Jeremy RW, Wilson MK, Vallely MP, Bannon PG

Woldendorp K, Starra E, Seco M, Hendel PN, Jeremy RW, Wilson MK, Vallely MP, Bannon PG

Heart Lung Circ 2014 Dec;23(12):1187-93

PMID: 25038031

Abstract

BACKGROUND: Composite valve-graft (CVG) replacement of the aortic root is a well-studied and recognised treatment for various aortic root conditions, including valvular disease with associated aortopathy. There have been few previous studies of the procedure in large numbers in an Australian setting.

METHOD: From January 2006 to June 2013, 246 successive patients underwent CVG root replacements at our institution. Mean age was 56.8 years, 85.4% were male, and 87 had evidence of bicuspid aortic valve. Indications for operation included ascending aortic aneurysm in 222 patients, annuloaortic ectasia in 67 patients, and aortic dissection in 38 patients.

RESULTS: The overall unit 30-day mortality was 5.7%, including: elective 30-day mortality of 2.2%, and emergent 30-day mortality of 17.2%. Statistically significant multivariate predictors of 30-day mortality were: acute aortic dissection (OR=20.07), peripheral vascular disease (OR=11.17), new ventricular tachycardia (OR=30.17), re-operation for bleeding (OR=14.42), concomitant mitral stenosis (OR=68.30), and cerebrovascular accident (OR=144.85).

CONCLUSIONS: Low postoperative mortality in our series matches closely with results from similar sized international studies, demonstrating that this procedure can be performed with low risk in centres with sufficient experience in the operative procedure.

The Freestyle Aortic Bioprosthesis: A Systematic Review

January 3, 2015December 2, 2014 by Sherrah AG, Edelman JJ, Thomas SR, Brady PW, Wilson MK, Jeremy RW, Bannon PG, Vallely MP

Sherrah AG, Edelman JJ, Thomas SR, Brady PW, Wilson MK, Jeremy RW, Bannon PG, Vallely MP

Heart Lung Circ 2014 Dec;23(12):1110-1117

PMID: 25047283

Abstract

BACKGROUND: The Medtronic Freestyle bioprosthesis (FSB) provides an alternative to other prostheses for both aortic valve and aortic root surgery. This paper is a systematic review of the post-operative outcomes in patients with aortic valve and/or aortic root disease following FSB implantation.

METHODS: Electronic databases were searched for primary analysis, prospective randomised studies comparing the FSB with an alternative aortic prosthesis were included. Additionally, case series that included data for at least 100 individual operated patients were used for secondary analysis.

RESULTS: Among three identified randomised studies, 199 FSB cases were compared with homografts, and stented and an alternative stentless bioprosthesis. The FSB showed comparable hospital mortality (4.5% vs 5.3%) and eight-year actuarial survival (80±5.0% versus 77±6.0%) with the homograft (respectively) and comparable reduction in left ventricular mass index relative to other prosthesis types. Over 6000 individual patients were included in the selected 15 case series. Weighted mean operative mortality, neurological event rate and five-year actuarial survival was 5.2%, 5.5% and 77.8%, respectively.

CONCLUSION: The FSB performed comparably against alternative prostheses regarding in-hospital mortality, long-term survival and reduction in left ventricular mass index. Included case series demonstrated robust post-operative outcomes in both the short and long term.

Early and Late Outcomes Following Valve Sparing Aortic Root Reconstruction: The ANZSCTS Database

Abstract

Nonsyndromic Thoracic Aortic Aneurysm and Dissection: Outcomes With Marfan Syndrome Versus Bicuspid Aortic Valve Aneurysm

Abstract

Thoracic aortic aneurysm: 4D flow MRI and computational fluid dynamics model

Abstract

Replacement of the aortic root with a composite valve-graft conduit: risk factor analysis in 246 consecutive patients

Abstract

The Freestyle Aortic Bioprosthesis: A Systematic Review

Abstract

Our Mission

Donate by Phone

About Us

Resources

You Can Help

Stay in the loop

Honour a Loved One

Challenge Yourself

Organise a community event

Seek sponsorship to help you quit those bad habits

Celebrate Through Giving

Aortic Root

Abstract

Abstract

Abstract

Abstract

Abstract

Our Mission

Donate by Phone

About Us

Resources

You Can Help

Stay in the loop

Honour a Loved One

Challenge Yourself

Organise a community event

Seek sponsorship to help you quit those bad habits

Celebrate Through Giving

Create a CrowdRaiser on GiveNow

Start a Facebook Fundraiser