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In this session presented by STS and the European Association for Cardio-Thoracic Surgery, international experts will examine the new concepts and techniques regarding the combination of bicuspid valve repair and aortic root resection and aneurysm treatment. Technical considerations, conduct of operations, surgical decision-making, and the most up-to-date data will be presented.
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Past Notes
Packed. For those of you standing,
you can come up front if you want
to. Our next speaker
is. Our next two speakers are the
other abstracts that were presented
and submitted.
Kanika Kalra Outcomes
of Valve Spring Route Replacement
versus traditional dental procedure
in patients with the shortest route
aneurysms enhanced non viscous
work valves.
Do you want us to stand here?
Yeah.
Thank you very much.
Good morning, everyone.
I'm Kanika Kalra and my first
year cardiothoracic surgery fellow
at Emory and I am pleased to be
here and to present our outcomes of
without spending due to placement in
comparison to mental procedure.
In patients with non-standard
bicuspid aortic valve,
I have nothing to disclose,
so about 50% of the patients
who have a viscous aortic valve will
develop an aortic aneurysm in
one or more segments of the aorta,
and more commonly they have aorta
group aneurysms, which have to be
repaired surgically.
The type of surgical technique
depends upon the primary aortic
valve pathology, for example,
in a standard, again, a very
calcified valve cause leaflets
cannot be spared.
We have to do a dental procedure,
which is primarily regurgitation.
Well, there are options to spare
the valve or do a dental
while the band or procedure has the
advantages of minimizing
future risk of why
there is a need for anticoagulation
lifetime with a mechanical valve
or structural deterioration
with the bioprosthetic.
Well, and on the other
hand, valve sparing root replacement
offers the advantages of preserving
the native valve.
But there's small risk of developing
II in the future.
Keeping these pros and cons in mind,
we hypothesized that valve sparing
root replacement may have similar
clinical outcomes compared to dental
procedure in this specific
patient population with non-standard
bicuspid valves.
So we looked at our institutions
data over 15
years and analyzed it in a
retrospective manner.
The SDS database and electronic
medical records were queried
for the preoperative operative
and post-operative clinical
outcomes.
The primary outcome was 30 day
mortality, long term mortality,
freedom from I, s and
re operation over the follow up
period.
So over half of the
412 patients
who had bicuspid aortic valve and
underwent aortic surgery,
we selected 288
who underwent root replacement.
We excluded hundred and 30 patients
who had aortic stenosis and were
left with a total number of 158
patients who underwent root
replacement with just II.
These were divided into two groups
78 received without sparing due
to placement and 80 received
ventral root replacement.
Looking at the preoperative
characteristics, the valve sweating
replacement patients were younger,
there were higher incidence of COPD
and diabetes in the root group.
The EOD group bandleader was
slightly high in the root group.
However, this difference of five
versus 5.3 is not very clinically
significant.
There was also also a higher
incidence of moderate to severe e
II. In the root group.
However, their ejection fraction
were similar
and the decision to spare the valve
was not dependent upon the
degree of fire.
It was just dependent on how good
the leaflets were, whether they were
calcified, or whether there were any
fan associations in the leaflets.
Patients who underwent isolated
router replacement.
They were centrally calculated while
patients who had any artwork they
were they had right axillary
cannulation with circa ast and
and degree of cerebral perfusion.
The cardiopulmonary bypass and cross
lamp times were higher in the valve
sparing due to placement,
but the circulatory arrest times
were similar between the two groups.
There was a higher incidence of
and triggered cerebral perfusion
being used in the route group, but
higher incidence of retrograde being
used in the Val sparing group.
About 60% patients repair
received cause of repair in the Val
sparing route replacement group.
18%
in the route group received a
mechanical val while 81%
received a bioprosthetic.
Well, the incidence of
concomitant procedures like
ascending hemi arch, total
arch cabbage or a double valve
was similar between the two groups
and so was the usage of
intraoperative balloon pump.
Looking at the outcomes, the
30 day mortality and length of stay
were similar between the two groups.
There was a higher incidence of
post-operative arrhythmias and
blood transfusion usage in the route
group.
The key post-operative
morbidities factors like cves
seizures, renal failure and
dialysis were similar between
the two groups and
no patient left the other with
greater than two BSI.
Also, the rate of re exploration for
hemorrhage was similar between the
two groups.
Doing echo analysis, the pre
and post operative gradients across
the VAL were similar between the
Val sparing route group
and the gradients
between the two groups.
Postoperatively were also similar.
This is a kaplan-meier curve showing
the survival over ten years
between the two groups and you can
see that those survivals
are equivalent.
This is a graph that
is plotting the
incidence of greater than one plus
or might die
alongside the competing risk
of that.
And this incidence was
equivalent between the two groups
also
and so was the incidence of removal
replacement
over five years.
And the incidence of valvular
degeneration as measured by degree
of s was also
equal and between the two groups
on a subanalysis of patients
who underwent custom repair in
the val sparing group about 60%
of them.
We saw that there was no degree of
moderate to severe eye aureus
in patients who underwent cuts, but
there was not.
So in conclusion, post-operative
morbidity and operative mortality
was pretty much equal.
And between the two groups in this
patient with nonstop Nordic viscous
speed belts, long term survival
was similar between the two groups.
Progression to moderate to severe
eye or regular degeneration
after valve sparing route
replacement was minimal and
equivalent to the route group.
Addition of course, prepared to the
Wellspring Group did not show any
adverse effects on the incidence of
future areas.
And all in all, while sparing
good replacement offered the
advantage of preserving the valve
and avoiding anticoagulation and
was especially suitable in younger
patients.
Thank you.
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