Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes

Authors

  • Jonathan M Hemli Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA http://orcid.org/0000-0002-6268-9216
  • Edward R. R. DeLaney Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA
  • Kush R. Dholakia Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA
  • Dror Perk Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA
  • Nirav C. Patel Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA
  • S. Jacob Scheinerman Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA
  • Derek R. Brinster Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA

DOI:

https://doi.org/10.1532/hsf.1825

Keywords:

aortic aneurysm, aortic root, ascending aorta, timing of surgery

Abstract

Background: Techniques for aortic surgery continue to evolve. A real-world snapshot of patients undergoing elective surgery for aneurysm in the modern era is helpful to assist in deciding the appropriate timing for intervention. We herein describe our experience with 100 consecutive patients who underwent primary elective surgery for aneurysm of the proximal thoracic aorta over a two-year period at a single institution.

Methods: The majority of our patients were male, mean age 61.19 ± 13.33 years. Two patients had Marfan syndrome. Twenty-eight patients had bicuspid aortic valve. Thirty-four patients underwent aortic root replacement utilizing a composite valve/graft conduit; 23 had valve-sparing root replacements. The ascending aorta was replaced in 89 patients;
80 (89.9%) of these included a period of circulatory arrest at moderate hypothermia utilizing unilateral selective antegrade cerebral perfusion.

Results: Thirty-day mortality was zero. Perioperative stroke occurred in 2 patients, both of whom completely recovered prior to discharge. No patients required
re-exploration for bleeding. One patient developed a sternal wound infection. Fifteen patients required readmission to hospital within thirty days of discharge.

Conclusion: Elective surgery for aneurysm of the proximal aorta is safe, reproducible, and is associated with outcomes that are superior to those seen in an acute aortic syndrome. It may be appropriate to offer surgery to younger patients with proximal aortic aneurysms at smaller diameters, even if their aortic dimensions do not yet meet traditional guidelines for surgical intervention.

Author Biography

Jonathan M Hemli, Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, New York, USA

Assistant Professor of Surgery, Hofstra Northwell School of Medicine at Hofstra University

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Published

2017-06-20

How to Cite

Hemli, J. M., R. DeLaney, E. R., Dholakia, K. R., Perk, D., Patel, N. C., Scheinerman, S. J., & Brinster, D. R. (2017). Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes. The Heart Surgery Forum, 20(3), E092-E097. https://doi.org/10.1532/hsf.1825

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