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The effect of adding an open distal anastomosis to proximal aneurysm repairs in bicuspid aortopathy

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Abstract

Objectives

To determine the role of adding open distal anastomosis to proximal aortic aneurysm repairs in bicuspid aortic valve (BAV) patients.

Methods

Retrospective review was performed of 1132 patients at our Aortic Center between 2005 and 2019. Inclusion criteria were all patients diagnosed with a BAV who underwent proximal aortic aneurysm repair with open or clamped distal anastomosis. Exclusion criteria were patients without a BAV, age < 18 years, aortic arch diameter ≥ 4.5 cm, type A aortic dissection, previous ascending aortic replacement, ruptured aneurysm, and endocarditis. Propensity score matching in a 2:1 ratio (220 clamped: 121 open repairs) on 18 variables was performed.

Results

Median follow-up time was 45.6 months (range 7.2–143.4 months). In the matched groups, no significant differences were observed between the respective open and clamped distal anastomosis groups for Kaplan Meier 10-year survival (86.9% vs. 92.9%; p = 0.05) and landmark survival analysis after 1 year (90.6%; vs. 93.3%; p = 0.39). Overall incidence of aortic arch-related reintervention was low (n = 3 total events). In-hospital complications were not significantly different in the open with respect to the clamped repair group, including in-hospital mortality (2.5% vs. 0.5%; p = 0.13) and stroke (0% vs. 0.9%; p = 0.54). In multivariable analysis, open distal anastomosis repair was not associated with long-term mortality (Hazard Ratio (HR) 1.98; p = 0.06).

Conclusion

We found no significant inter-group differences in survival, reintervention, or in-hospital complication rates, with low rates of mortality, and aortic arch-related reintervention, suggesting adding open distal anastomosis may not provide benefit in BAV patients undergoing proximal aortic aneurysm repairs.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY, 10032, USA

    Christian Pearsall, Philip M. Allen, Yanling Zhao, Ilya Kim, Casidhe Bethancourt, Diane Hu, Paul A. Kurlansky, Isaac George, Craig R. Smith & Hiroo Takayama

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  1. Christian Pearsall
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  2. Philip M. Allen
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  7. Paul A. Kurlansky
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  8. Isaac George
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  10. Hiroo Takayama
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Corresponding author

Correspondence to Hiroo Takayama.

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Conflict of interest

Dr. Isaac George has received Institutional funding to Columbia University from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, JenaValve. Dr. Isaac George has received speaker honoraria from Zimmer Biomet, Atricure, Neosurgery, Neptune Medical, Abbvie, Johnson & Johnson, Boston Scientific and owns stock in Valcare Medical, Durvena, CardioMech, Vdyne, MitreMedical, MITRx. Dr. Isaac George is a member of Edwards Surgical, Medtronic Surgical, Trisol Medical, Abbvie, Johnson & Johnson, Foldax Medical, Zimmer Biomet, Neosurgery, Abbvie, and Boston Scientific advisory boards. The remaining authors declare that they have no conflicts of interest.

Institutional review board (IRB) approval

This study was approved March 31st, 2020 by the IRB at Columbia University (AAAR2949).

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Pearsall, C., Allen, P.M., Zhao, Y. et al. The effect of adding an open distal anastomosis to proximal aneurysm repairs in bicuspid aortopathy. Gen Thorac Cardiovasc Surg 71, 455–463 (2023). https://doi.org/10.1007/s11748-023-01907-w

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  • DOI: https://doi.org/10.1007/s11748-023-01907-w

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