Abstract 13176: Perioperative and Late Outcomes After Thoracic Aortic Replacement for Giant Cell Aortitis: A Canadian Thoracic Aorta Collaborative Experience

Introduction:Giant cell arteritis is well described in temporal arteritis. Involvement of the aorta is characterized as Giant Cell Aortitis (GCA). Patients with GCA may need replacement of a segment of the thoracic aorta. Data regarding patient characteristics, perioperative and long term outcomes of GCA after replacement of the thoracic aorta are sparse. We aim to report perioperative and mid-term results in patients with GCA.Methods:A retrospective review, since 2003, among three high volume centers was conducted. 116 consecutive patients operated for thoracic aortic aneurysm with a histological diagnosis of GCA were identified. Mean clinical and imaging follow-up was 4.9 +/- 3.4 years.Results:Mean age was 70.3?9.3 yo; 76/116 (66.7%) were female. Preoperatively, 16 patients had a diagnosis of temporal arteritis with 8 patients on oral glucocorticoids and/or methotrexate. Elective aortic replacement was performed in 96.6%. All patients had a replacement of the ascending aorta and 84 (72.4%) had a concomitant arch procedure (68/84 hemiarch and 16/84 total arch). A concomitant hybrid TEVAR to replace the descending aorta was performed in 9 patients while 2 additional patients required a late TEVAR procedure for disease progression. An aortic valve procedure was conducted in 89 patients (76.7%): AVR/Bentall in 40/89 patients and valve sparing in 49/89 patients. Mean CPB time and cross clamp time were 123.2? 55.6 minutes and 79.8 ? 41.8 minutes respectively. Three patients (2.6%) died in-hospital, 6 patients (5.2%) were reoperated for bleeding and 10 patients (8.6%) had a postoperative TIA/CVA. Overall survival at 1, 5 and 7 years was respectively 95.7%, 96.2% and 78.5%. Freedom from reoperation at 1, 5 and 7 years was respectively 96.1%, 92.4% and 89.3%. Among the 11 patients with a TEVAR procedure (mean FU: 45.5?26.9 months), five (45.5%) had a type IB endoleak; two requiring a TEVAR extension.Conclusions:GCA is a diffuse disease always involving the ascending aorta and often extending in the arch. Although complex aortic surgery is required, early and mid-term outcomes are favourable. Long term imaging follow-up is mandatory to identify disease progression on other aortic segments. Use of TEVAR is controversial owing to the diffuse aortic involvement.