Vol. 20 JA2016 - cardiac

C-11 – Type A acute aortic syndrome: results at five years in a 24/7 aortic emergency centre (SOS Aorta registry)

Ramzi Abi Akar, Milos Matkovic, Julien Massot, Alain Bel, Jerôme Jouan, Léonora du Puy-Montbrun, Jean-Marc Alsac, Bernard Cholley, Florence Bellenfant, Romain Pirracchio, Christian Latremouille, Jean-Noël Fabiani, Paul Achouh Institution : Département de chirurgie cardiovasculaire, département d’anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, Paris Objectives : SOS Aorta is a program put in place in a university hospital for an immediate, round-the-clock, multidisciplinary protocolled management of all aortic emergencies. Acute aortic syndrome is the most frequent aortic emergency. It is an absolute complex surgical emergency, with a high initial mortality rate. The aim of this paper is to evaluate the characteristics, in-hospital mortality, short and mid term results of patients referred to this aortic emergency program for suspected or confirmed type A acute aortic syndrome (AAS) Methods : From february 2010 to May 2015: 688 patients were admitted through the SOS aorta program for suspected or confirmed aortic emergencies. All patients were entered into a prospective database. Initially, 129 patients were referred to our center with the diagnosis of type A acute aortic syndrom (AAS) based on a pre-admission CT-scan. And 74 patients were directly referred from the Mobile Emergency Units with high suspiscion of AAS. Of the 74 patients referred with high suspiscion of AAS: the diagnosis was confirmed with CT-scan on admission in 61; 13 patients were immediatly transferred to the operating room for a TEE confirmation, because in shock or cardiac arrest. We reviewed the characteristics of these patients on admission and their in-hospital mortality. We also reviewed the results at five years regarding their survival and the need for reintervention. Results : Procedural mortality was 15% for hemodynamically stable patients and 100% for patients under mechanical cardiac resuscitation. In hospital mortality was 23, 38 and 51% for patients under 70 years old, septuagenarians and octogenarians respectively. At discharge, global mortality was 30%. 44% of operated patients were transferred to cardiovascular rehabilitation centers and 16% were send home directly. Conclusion : Management of AAS in a round-the-clock, multidisciplinary aortic emergencies program reduces the time to treatment. This theoretically should allow improvement in survival. The benefit in survival is probably counterbalanced by a higher percentage of unstable and critical patients admitted through the program. Mortality is certain in patients who present with cardiac arrest before surgery. Octogenarian have a significantly higher in-hospital mortality rate.
novembre 29, 2016
Vol. 20 JA2016 - cardiac

C-12 – Redo operations for aneurysm of ascending aorta after previous aortic valve replacement: a purpose of 17 cases

Hakim Himeur, Mourad Aouiche, Rym Bourezak, Abderazak Moussaoui, Rachid Ait Mohand, Chafik Bendamerdji, Salah Eddine Bourezak Institution : Service de chirurgie cardiovasculaire, EHS Mohamed-Abderrahmani, Bir Mourad Rais, Alger, Algérie Objectives : Five to fifteen percent of patient undergoing aortic valve replacement (AVR) will have an ascending aortic aneurysm requiring a concomitant surgical procedure. The aim of this study was to evaluate the early and late results for complex surgical procedure of the proximal aorta after previous aortic valve replacement (AVR). Methods : Between May 2004 to August 2016; 17 patients underwent ascending aortic replacement secondary to aortic valve surgery and mostly for aortic valve replacement (AVR). (12) Males and five (05) Females, mean age 42 years. Mono leaflet prosthesis (03), Starr (03), Double leaflet (06), Bioprosthesis (01), congenital aortic valve stenosis, wrapping of annulo-aortic ectasia (01). The mean time between the first procedure and redo surgery is 20 years. Results : The 30 days mortality rate is (2/17); emergency repair is associated with higher early mortality. The global survival with the Kaplan-meier method is 93% at 05 years. Conclusion : Redo surgery for aneurysm of ascending aorta is a major surgical challenge with high postoperative mortality. Patients are at risk for later dissection or rupture of the aortic wall. Elective re-operation for ascending aorta can be accomplished with acceptable mortality.
novembre 29, 2016
Vol. 20 JA2016 - cardiac

C-13 – Long-term outcomes following mitral valve surgery in octogenarians

Michel Kindo, Tam Hoang Minh, Stéphanie Perrier, Jonathan Bentz, Clément Schneider, Yi Yang, Sarra Benmouhoub, Dharmesh Ramlugun, Anna-Maria Deaconu, Marion Kibler, Alexandre Vorburger, Anne-Lorraine Bourquiaux, Arnaud Mommerot, Philippe Billaud, Jean-Philippe Mazzucotelli Institution : Service de chirurgie cardiaque, hôpitaux universitaires de Strasbourg Objectives : In our practice, mitral valve surgery in octogenarians is associated with satisfactory in-hospital mortality. The aims of this study were to assess mitral valve surgery in octogenarians regarding long-term survival and quality of life. Methods : Between 2000 and 2014, 132 consecutive octogenarians (mean age of 82.7±2.4) years) underwent mitral repair (MVA n=62, 47.0%) or mitral replacement (MVR, n=70, 53.7%). One or more associated procedures were performed in 71 patients (53,0%). The study population was divided into 4 groups according to the type of mitral surgery performed: 19.7% (n=26) were in the isolated MVA group; 26.5% (n=35), in the isolated MR group; 27.3% (n=36), in the combined MVR group; and 26,5% (n=35), in the combined MVR group. The overall mean EuroSCORE II was 9.7±9.6%. Overall hospital mortality was 8.3%. The mean follow-up was 4.1±3.3 years and 3 patients were lost during the follow-up. Results : Overall survival rates at 1, 3 and 5 and 10 years were 86.9±3.0%, 81.9±3.5% and 74.5±4.5% respectively. Survival rates after MVA and MVR surgeries at 1, 3 and 5 years were 91.8±3.5% versus 87.0±4.1%, 83.7±5.5% versus 79.4±4.9% and 79.7±6.5% versus 69.9±6.2%; respectively (log-rank test=0.082). There was no significant difference in survival rates between the 4 groups (log-rank test=0.142). At last follow-up, most patients experienced a significant improvement of their functional status, with 89.1% in NYHA class I or II. A total of 81.6% of the patients were living at home whereas 5.9% were living in a nursing home, with altered cognitive function. Three patients (2.5%) had a permanent stroke during the follow-up. When excluding patients who died during the in-hospital period, 92.0% and 94.1% of the patients in the isolated MVA and combined MVA groups, respectively, had mitral regurgitation below grade 2. Conclusion : In our study, mitral valve surgery in octogenarians was associated with satisfactory long-term survival and quality of life. The age of the patient and the complexity of the surgery thus should not be limiting factors for mitral surgery.
novembre 29, 2016
Vol. 20 JA2016 - cardiac

C-14 – Deleterious effects of loss of independence assessed with the Katz Index after aortic valve replacement in elderly patient

Nicolas d’Ostrevy, Hung Ngo Thanh, Céline Lambert, Frédéric Martins-Condé, Gildas Coutu, Bruno Lesourd, Bruno Pereira, Kasra Azarnoush, Lionel Camilleri Institution : Service de chirurgie cardiovasculaire, CHU Gabriel-Montpied, Clermont-Ferrand Objectives : The aim of this study was to distinguish among elderly patients those whose postoperative evolution further to surgical aortic valve replacement was unsatisfactory and to seek for geriatric tests predictive of this evolution. Methods : We prospectively evaluated the incidence, over early and late results, of surgical scores and geriatric profile amid 122 intermediate-risk patients, aged 75 years or more who underwent surgical aortic valve replacement. Results : In a univariate analysis, the EuroScore II (OR 1.73, 95% CI: 1.21-2.48, P=0.002), STS score (OR 1.39, 95% CI: 1.03-1.88, P=0.03) and a Katz index ≤5 (limitation of at least one daily living activity) (OR 3.35, 95% CI: 1.08-10.35, P=0.03) were predictors of a 30-day unfavorable evolution. In a multivariate analysis, only surgical scores were predictive factors. At 6 months, 20 patients had deceased or had to be readmitted to hospital. At 10 years, survival was 48% [IQR 39-57]. The Katz index ≤5 was the only geriatric test independent of an unfavorable outcome at 6 months (OR 4.51, 95% CI: 1.25-16.29, P=0.02) and of a deleterious effect over long-term survival (OR 3.00, 95% CI: 1.58-5.69, P=0.001). Conclusion : In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.
novembre 29, 2016
Vol. 20 JA2016 - cardiac

C-15 – Anatomical study of the internal thoracic arteries: implications for use in coronary artery bypass graft surgery

Cécile Martin, Benjamin Romary, Olivier Chavanon Institution : Service de chirurgie cardiaque, pôle Thorax Vaisseaux, CHU Grenoble-Alpes Objectives : The feasibility of coronary artery bypass grafting using an internal thoracic artery (ITA) depends on the length of the graft with respect to the optimal route to reach the coronary target. The goal of this study was to assess the gain in length afforded by skeletonization and to evaluate the lengths of different pathways of the ITAs to the left coronary arteries. Methods : It was an anatomical study performed on human cadavers. The left and right ITAs were dissected out from 20 specimens and measured before and after skeletonization. Distance between the origin of the right ITA and the base of the left atrial appendage, corresponding to the proximal circumflex artery, was measured for both the transverse pericardial sinus and preaortic routes. Results : Skeletonization gave a significant gain of length for both ITAs. Analysis showed no significant correlation between the ITA length and the height, weight, and BMI of specimens. We found no association between the length of the sternum and the length of skeletonized RITA or LITA. The anterior route of the skeletonized right ITA was shorter than the transverse pericardial sinus route in 18 cases. The average length to the circumflex artery territory was 132.8±23.5 mm in front of the aorta and 150.5±18.8 through the transverse pericardial sinus with a gain of length of 17.7 mm (p<0.0001). Conclusion : Skeletonization gave significant gains in length of both ITAs. The preaortic route for the skeletonized right ITA toward the circumflex territory was shorter than the transverse pericardial sinus route in 90% of cases.
novembre 29, 2016
Vol. 20 JA2016 - cardiac

C-16 – Longterm outcomes after concomitant cardiac surgery and ascending aorta to bifemoral bypass

Côme Bosse, Ramzi Ramadan, Rémi Nottin, Dominique Fabre, Olaf Mercier, Philippe Deleuze, Julien Guihaire Institution : Service de chirurgie cardiaque adultes, centre chirurgical Marie-Lannelongue, Le Plessis-Robinson Objectives : A subset of patients referred for coronary artery bypass grafting (CABG) or valvular surgery present with sever leg ischemia from Cardiac diseases and aorto-iliac occlusion frequently coexist in the same patients. The ascending aorta has been reported as a being a good source ofgood inflow site for bifemoral bypass.We sought to investigate the post-operative outcomes and long-term patency of this prosthetic ventral aorta when combined with synchronous cardiac surgery combined with ascending aorta to bifemoral bypass. Methods : Seven patients with a mean age of 64 (47-75), underwent concomitant ventral aorta and of which 6 for CABG (n=6) or and 1 aortic valve replacement (n=1) , underwent surgery through median sternotomy between 2010 and 2016. After weaning from cardiopulmonary bypass, a dacron or PTFE prosthetic tube conduit (Dacron of PTFE, diameter 8 to 16 mm) was sutured to the ascending aorta and led to both femoral arteries, used and either as an Y bifemoral anastomosis graft or as a right femoral anastomosis graft associated with cross-femoral bypass was performed. Long-term graft patency was investigated by physical examination and CT angiogram. Results : Five (71%) patients were Leriche stage 2B and had a 54% mean left ventricular functionheart function preoperatively. 5 patients underwent the Y bifemoral approach and 2 patients had a right aorto-femoral bypass combined with cross-femoral bypass. No perioperative deaths and no major complications related to the prosthetic ventral aorta occurred. Average length of stay was 12 days (4-19). Mean follow-up was 23 months (1-66). At five years, all grafts were patent except for one distal left branch. Conclusion : In patients with concomitant cardiac disease and aorto-iliacdiseases chronic occlusion, ascending aorta to bifemoral bypass combined with cardiac surgery is a safe strategy providing favorable outcomes.
novembre 29, 2016